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OUTLINES  OF 
GREEK  AND  ROMAN  MEDICINE 


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From  Wellcome' 3  Medical  Diary  (Copyright) 
By  permission  of  Burrougbs  Wellcome  &  Co. 


ASKLEPIOS 

The  ancient  Greek  Deity  of  Healing. 


OUTLINES  OF 
GREEK  AND  ROMAN  MEDICINE 


BY 


JAMES   SANDS   ELLIOTT,    M.D.,    Ch.B.(Edin.) 

Editor  of  the  •'  New  Zealand  Medical  Journal," 
Honorary  Surgeon  to  the  Wellington  Hospital,  New  Zealand. 


5llustrate& 


NEW    YORK 
WILLIAM    WOOD    AND    COMPANY 
MDCCCCXIV. 


.SI- 


% 

o 


TO  MY  FATHER 


PEBFACE. 


I  WAS  stimulated  to  write  these  Outlines  of 
Greek  and  Eoman  Medicine  by  a  recent  sojourn 
in  the  south-eastern  part  of  Europe.  The  name 
of  the  book  defines,  to  some  extent,  its  limitations, 
for  my  desire  has  been  to  give  merely  a  general 
outline  of  the  most  important  stages  in  the 
advancement  of  the  healing  art  in  the  two  Empires 
to  which  modern  civilization  is  most  deeply 
indebted.  There  are  a  few  great  works  on  the 
history  of  medicine  by  continental  writers,  such, 
for  instance,  as  those  by  the  German  writers, 
Baas,  Sprengel,  and  Puschmann,  but,  generally 
speaking,  the  subject  has  been  much  neglected. 

I  cherish  the  hope  that  this  little  work  may 
appeal  to  doctors,  to  medical  students,  and  to 
those  of  the  public  who  are  interested  in  a 
narration  of  the  progress  of  knowledge,  and  who 
realize  that  the  investigation  of  the  body  in 
health  and  disease  has  been  one  of  the  most 
important  features  of  human  endeavour. 

The  medical  profession  deserves  censure  for 
neglect  of  its  own  history,  and  pity  'tis  that  so 
many  practitioners  know  nothing  of  the  story  of 
their  art.  For  this  reason  many  reputed  dis- 
coveries are  only  re-discoveries ;  as  Bacon  wrote : 


Vlll  PREFACE 

"  Medicine  is  a  science  which  hath  been,  as 
we  have  said,  more  professed  than  laboured,  and 
yet  more  laboured  than  advanced  ;  the  labour 
having  been,  in  my  judgment,  rather  in  circle  than 
in  progression.  For  I  find  much  iteration,  and 
small  progression."  Of  late  years,  however,  the 
History  of  Medicine  has  been  coming  into  its 
kingdom.  Universities  are  establishing  courses  of 
lectures  on  the  subject,  and  the  Royal  Society 
of  Medicine  recently  instituted  a  historical  section. 

The  material  I  have  used  in  this  book  has  been 
gathered  from  many  sources,  and,  as  far  as  possible, 
references  have  been  given,  but  I  have  sought  for, 
and  taken,  information  wherever  it  could  best  be 
found.  As  Montaigne  wrote  :  "I  have  here  only 
made  a  nosegay  of  culled  flowers,  and  have 
brought  nothing  of  my  own  but  the  thread  that 
ties  them  together." 

I  have  to  express  my  indebtedness  to  my  friend, 
Mr.  J.  Scott  Eiddell,  M.V.O.,  M.A.,  M.B.,  CM., 
Senior  Surgeon,  Aberdeen  Royal  Infirmary,  for  his 
great  kindness  in  reading  the  proof-sheets,  pre- 
paring the  index  and  seeing  this  book  through  the 
press  and  so  removing  one  of  the  difficulties  which 
an  author  writing  overseas  has  to  encounter ;  also 
to  my  publishers  for  their  courtesy  and  attention, 

James  Sands  Elliott. 

Wellington, 
New  Zealmid. 

January  5,  1914. 


CONTENTS. 

CHAPTER   I. 

Early  Roman  Medicine. 

PAGE 

Origin  of  Healing — Temples — Lectisternium — Temple  of 
^gculapius  —  Archagathus — Domestic  Medicine — 
Greek  Doctors — Cloaca  Maxima — Aqueducts — State 
of  the  early  Empire      ...         ...         1 

CHAPTER  II. 

Early  Greek  Medicine. 

Apollo  —  ^sculapius  —  Temples  —  Serpents  —  Gods  of 
Health  —  Melampus  —  Homer  —  Maehaon  —  Poda- 
larius — Temples  of  ^sculapius — Methods  of  Treat- 
ment —  Gymnasia  —  Classification  of  Renouard  — 
Pythagoras — Democedes — Greek  Philosophers      ...       13 

CHAPTER  III. 

Hippocrates. 

His  life  and  works — His  influence  on  Medicine  ...         ...       25 

CHAPTER   IV. 

Plato,  Aristotle,  the  School  op  Alexandria,  and 
Empiricism. 

Plato — Aristotle — Alexandrian  School — Its  Origin — Its 
Influence— Lithotomy — Herophilus — Erasistratus — 
Cleombrotus  —  Chrysippos  —  Anatomy — Empiricism 
— Serapion  of  Alexandria        ...         ..,         .,,         ...       39 


X  CONTENTS 

PAGE 

CHAPTEE  V. 

EoMAN  Medicine  at  the  end  op  the  Eepubltc  and  the 

BEGINNING   OP   THE    EiMPIKE. 

Aselepiades  of  Prusa — Themison  of  Laodieea — Method- 
ism— Wounds  of  Julius  Csesar — Systems  of  Philo- 
sophy—  State  of  the  country  —  Eoman  quacks  — 
Slaves  and  Freedmen — Lucius  Horatillavus  ...       51 

CHAPTEE  VI. 

In  the  Eeign  op  the  C^sars  to  the  Death  op  Nero. 

Augustus — His  illnesses — Antonius  Musa — Maecenas — 
Tiberius  —  Caligula  —  Claudius  —  Nero  —  Seneca — 
Astrology — Archiater — Women  poisoners — Oculists 
in  Eome  ...         ...         , 63 

CHAPTEE  VII. 

Physicians  prom  the  Time  op  Augustus  to  the  Death 

OP  Need. 

Celsus — His  life  and  works — His  influence  on  Medicine 
— Meges  of  Sidon — Apollonius  of  Tyana — Alleged 
miracles  — -  Vettius  Valleus  —  Scribonius  Longus — 
Andromachus — Thessalus  of  Tralles — Pliny  ...       72 

CHAPTEE   VIII. 
The  First  and  Second  Centuries  op  the  Christian  Era. 

AthenaBus — Pneumatism  —  Eclectics  —  Agathinus  —  Are- 
tffius  —  Archigenes  —  Dioscorides — Cassius  Eelix — 
Pestilence  in  Eome — Ancient  surgical  instruments 
—  Herodotus  —  Heliodorus  —  Cselius  Aurelianus  — 
Soranus — Eufus  of  Ephesus — Marinus — Quintus  ...       86 

CHAPTEE   IX. 

Galen. 

His  life  and  works — His  influence  pn  Medicine  ...         . , .       96 


CONTENTS  XI 

PAGE 

CHAPTEE   X. 

The  Later  Eoman  and  Byzantine  Period. 

Beginning  of  Decline — Neoplatonism — Antyllus — Oriba- 
sius — Magnus — Jacobus     Psychi-istus — Adamantius 

—  Melefcius  —  Nemesius  —  ^tius  —  Alexander    of 
Tralles — The   Plague — Moscbion — Paulus   ^gineta 

— Decline  of  Healing  Ait        ,..         ...         ...         ...     Ill 

CHAPTEE   XL 

Influence  of  Christianity  on  Altruism  and  the 
Healing  Art. 

Essenes— Cabalists  and  Gnostics — Object  of  Christ's 
Mission — Stoics — Constantino  and  Justinian — Gla- 
diatorial Games — Orphanages — Support  of  the  Poor 
— Hospitals — Their  Foundation — Christianity  and 
Hospitals  —  Fabiola  —  Christian  Philanthropy  — 
Demon  Theories  of  Disease  receive  the  Church's 
Sanction — Monastic  Medicine — Miracles  of  Healing 

—  St.     Paul  —  St.     Luke  —  Proclus  —  Practice     of 
Anatomy  denounced — Christianity  the  prime  factor 

in  promoting  Altruism  ...         •.,.  ...  ...     127 

CHAPTEE   XII. 

Gymnasia  and  Baths. 

Gymnastics — Vitruvius — Opinions  of  Ancient  Physicians 
on  Gymnastics  —The  Athletes — The  Baths — Descrip- 
tion of  Baths  at  Pompeii — Thermae — Baths  of  Cara- 
calla        143 

CHAPTEE   XIII. 

Sanitation. 

Water-supply — Its  extent — The  Aqueducts — Distribu- 
tion in  city — Drainage — Disposal  of  the  Dead — 
Cremation  and  Burial — Catacombs — Public  Health 
Eegulations       ...         ...         ...         ...         ...         ...     155 

APPENDIX. 

Fees  in  Ancient  Times    ...         ...         ...         ...         ...     162 


ILLUSTRATIONS. 


x\sklepios,  the  ancient  Greek  Deity  of  Healing         frontispiece 

Machaon  (Son  of   Asklepios),    the   first   Greek   MiHtary 

Surgeon,  attending  to  the  wounded  Menelaus  p.  17 


Plate    I. — Bust  of  ^sculapius 

,,      II. — Hygeia,  the  Greek  Deity  of  Health    ... 

,,   III. — Facade  of  Temple  of  Asklepios,  restored 
(Delfrasse) 

,,    IV. — Health  Temple,  restored  (Caton) 


face  p. 

13 

)j 

15 

>5 

18 
20 

OUTLINES  OF 

Greek  and   Roman  Medicine 


CHAPTEE  I. 

EAELY  EOMAN   MEDICINE. 

Origin  of  Healing  —  Temples — Lectisternium — Temple  of 
^sculapius  —  Archagathus — Domestic  Medicine — Greek 
Doctors — Cloaca  Maxima — Aqueducts — State  of  the  early 
Empire. 

The  origin  of  the  healing  art  in  Ancient  Home 
is  shrouded  in  uncertainty.  The  earhest  practice 
of  medicine  was  undoubtedly  theurgic,  and  common 
to  all  primitive  peoples.  The  of&ces  of  priest  and 
of  medicine-man  were  combined  in  one  person, 
and  magic  was  invoked  to  take  the  place  of  know- 
ledge. There  is  much  scope  for  the  exercise  of  the 
imagination  in  attempting  to  follow  the  course  of 
early  man  in  his  efforts  to  bring  plants  into 
medicinal  use.  That  some  of  the  indigenous 
plants  had  therapeutic  properties  was  often  an 
accidental  discovery,  leading  in  the  next  place  to 
experiment  and  observation.  Cornelius  Agrippa, 
in  his  book  on  occult  philosophy,  states  that  man- 
kind has  learned  the  use  of  many  remedies  from 
animals.  It  has  even  been  suggested  that  the 
use  of  the   enema  was  discovered  by  observing  a 


ii  GREEK  AND   EOMAN   MEDICINE 

long-beaked  bird  drawing  up  water  into  its  beak, 
and  injecting  the  water  into  the  bowel.  The 
practice  of  healing,  crude  and  imperfect,  pro- 
gressed slowly  in  ancient  times  and  was  conducted 
in  much  the  same  way  in  Kome,  and  among  the 
Egyptians,  the  Jews,  the  Chaldeans,  Hindus  and 
Parsees,  and  the  Chinese  and  Tartars. 

The  Etruscans  had  considerable  proficiency  in 
philosophy  and  medicine,  and  to  this  people,  as 
well  as  to  the  Sabines,  the  Ancient  Eomans  were 
indebted  for  knowledge.  Numa  Pompilius,  of 
Sabine  origin,  who  was  King  of  Eome  715  B.C., 
studied  physical  science,  and,  as  Livy  relates,  was 
struck  by  lightning  and  killed  as  the  result  of  his 
experiments,  and  it  has  therefore  been  inferred 
that  these  experiments  related  to  the  investigation 
of  electricity.  It  is  surprising  to  find  in  the 
Twelve  Tables  of  Numa  references  to  dental 
operations.  In  early  times,  it  is  certain  that  the 
Eomans  were  more  prone  to  learn  the  superstitions 
of  other  peoples  than  to  acquire  much  useful 
knowledge.  They  were  cosmopolitan  in  medical 
art  as  in  religion.  They  had  acquaintance  with 
the  domestic  medicine  known  to  all  savages, 
a  little  rude  surgery,  and  prescriptions  from  the 
Sibylline  books,  and  had  much  recourse  to  magic. 
It  was  to  Greece  that  the  Eomans  first  owed  their 
knowledge  of  healing,  and  of  art  and  science 
generally,  but  at  no  time  did  the  Eomans  equal 
the  Greeks  in  mental  culture. 


EAELY  EOMAN   MEDICINE  3 

Pliny  states  that  "  the  Eoman  people  for  more 
than  six  hundred  years  were  not,  indeed,  without 
medicine,  but  they  were  without  physicians." 
They  used  traditional  family  recipes,  and  had 
numerous  gods  and  goddesses  of  disease  and 
healing.  Febris  was  the  god  of  fever.  Mephitis 
the  god  of  stench ;  Fessonia  aided  the  weary,  and 
"  Sweet  Cloacina "  presided  over  the  drains. 
The  plague  -  stricken  appealed  to  the  goddess 
Angeronia,  women  to  Fluonia  and  Uterina. 
Ossipaga  took  care  of  the  bones  of  children,  and 
Carna  was  the  deity  presiding  over  the  abdominal 
organs. 

Temples  were  erected  in  Eome  in  467  B.C.  in 
honour  of  Apollo,  the  reputed  father  of  ^sculapius, 
and  in  460  B.C.  in  honour  of  ^sculapius  of 
Epidaurus.  Ten  years  later  a  pestilence  raged 
in  the  city,  and  a  temple  was  built  in  honour  of 
the  Goddess  Salus.  By  order  of  the  Sibylline 
books,  in  399  B.C.,  the  first  lectisternium  was  held 
in  Eome  to  combat  a  pestilence.  This  was  a 
festival  of  Greek  origin.  It  was  a  time  of  prayer 
and  sacrifice ;  the  images  of  the  gods  were  laid 
upon  a  couch,  and  a  meal  was  spread  on  a  table 
before  them.  These  festivals  were  repeated  as 
occasion  demanded,  and  the  device  of  driving  a 
nail  into  the  temple  of  Jupiter  to  ward  off  "  the 
pestilence  that  walketh  in  darkness,"  and  "  destruc- 
tion that  wasteth  at  noonday  "  was  begun  360  B.C. 
As  evidence  of  the  want  of  proper  surgical  knowledge. 


4  GREEK  AND   ROMAN   MEDICINE 

the  fact  is  recorded  by  Livy  that  after  the 
Battle  of  Sutrium  (309  B.C.)  more  soldiers  died  of 
wounds  than  were  killed  in  action.  The  worship 
of  ^sculapius  was  begun  by  the  Eomans  291  B.C., 
and  the  Egyptian  Isis  and  Serapis  were  also 
invoked  for  their  healing  powers. 

At  the  time  of  the  great  plague  in  Eome 
(291  B.C.),  ambassadors  were  sent  to  Epidaurus,  in 
accordance  with  the  advice  of  the  Sibylline  books, 
to  seek  aid  from  ^sculapius.  They  returned  with 
a  statue  of  the  god,  but  as  their  boat  passed  up  the 
Tiber  a  serpent  which  had  lain  concealed  during 
the  voyage  glided  from  the  boat,  and  landing  on 
the  bank  was  welcomed  by  the  people  in  the 
belief  that  the  god  himself  had  come  to  their  aid. 
The  Temple  of  ^sculapius,  which  was  built  after 
this  plague  in  291  B.C.,  was  situated  on  the  island 
of  the  Tiber.  Tradition  states  that,  when  the 
Tarquins  were  expelled,  their  crops  were  thrown 
into  the  river,  and  soil  accumulated  thereon  until 
ultimately  the  island  was  formed.  In  consequence 
of  the  strange  happening  of  the  serpent  landing 
from  the  ship  the  end  of  the  island  on  which  the 
Temple  of  ^sculapius  stood  was  shaped  into  the 
form  of  the  bow  of  a  ship,  and  the  serpent  of 
^sculapius  was  sculptured  upon  it  in  relief. 

The  island  is  not  far  from  the  ^milian  Bridge, 
of  which  one  broken  arch  remains. 

Ovid     represents     this     divinity     as     speaking 
thus  : — 


EARLY  ROMAN   MEDICINE  5 

"  I  come  to  leave  my  shrine  ; 
This  serpent  view,  that  with  ambitious  play 
My  staff  encircles,  mark  him  every  way  ; 
His  form — though  larger,  nobler,  I'll  assume, 
And,  changed  as  gods  should  be,  bring  aid  to  Eome." 
(Ovid,  "  Metamorphoses,"  xv.) 

He  is  said  to  have  resumed  his  natural  form  on 
the  island  of  the  Tiber. 

"  And  now  no  more  the  drooping  city  mourns  ; 
Joy  is  again  restored  and  health  returns." 

It  was  the  custom  for  patients  to  sleep  under  the 
portico  of  the  Temple  of  ^sculapius,  hoping  that 
the  god  of  the  healing  art  might  inspire  them  in 
dreams  as  to  the  system  of  cure  they  should  adopt 
for  their  illnesses.  Sick  slaves  were  left  there  by 
their  masters,  but  the  number  increased  to  such  an 
extent  that  the  Emperor  Claudius  put  a  stop  to  the 
cruel  practice.  The  Church  of  St.  Bartholomew 
now  stands  on  the  ruins  of  the  Temple  of 
^sculapius. 

Even  in  very  early  times,  however,  Rome  was 
not  without  medical  practitioners,  though  not  so 
well  supplied  as  some  other  nations.  The  Lex 
Emilia,  passed  433  B.C.,  ordained  punishment  for 
the  doctor  who  neglected  a  sick  slave.  In  Plutarch's 
"Life  of  Cato"  (the  Censor,  who  was  born  in  234  B.C.), 
we  read  of  a  Boman  ambassador  who  was  sent 
to  the  King  of  Bithynia,  in  Asia  Minor,  and  who 
had  his  skull  trepanned. 

The  first  regular  doctor  in  Rome  was  Archagathus, 


fa  GBEEK  AND   EOMA.N    MEDICINE 

who  began  practice  in  the  city  219  B.C.,  when  the 
authorities  received  him  favourably  and  bought 
a  surgery  for  him ;  but  his  methods  were  rather 
violent,  and  he  made  much  use  of  the  knife  and 
caustics,  earning  for  himself  the  title  of  "butcher," 
and  thus  having  fallen  into  disfavour,  he  was  glad 
to  depart  from  Eome.  A  College  of  ^sculapius 
and  of  Health  was  established  154  B.C.,  but  this 
was  not  a  teaching  college  in  the  present  meaning 
of  the  term. 

The  doctors  of  Ancient  Eome  took  no  regular 
course  of  study,  nor  were  any  standards  specified, 
but  as  a  rule  knowledge  was  acquired  by  pupilage 
to  a  practising  physician,  for  which  a  honorarium 
was  paid.  Subsequently  the  Archiatri,  after  the 
manner  of  trade  guilds,  received  apprentices,  but 
Pliny  had  cause  to  complain  of  the  system  of 
medical  education,  or  rather,  to  deplore  the  want 
of  it.  He  wrote:  "People  believed  in  anyone  who 
gave  himself  out  for  a  doctor,  even  if  the  false- 
hood directly  entailed  the  greatest  danger.  Un- 
fortunatety,  there  is  no  law  w^hich  punishes  doctors 
for  ignorance,  and  no  one  takes  revenge  on  a  doctor 
if  through  his  fault  someone  dies.  It  is  permitted 
him  by  our  danger  to  learn  for  the  future,  at  our  death 
to  make  experiments,  and,  without  having  to  fear 
punishment,  to  set  at  naught  the  life  of  a  human 
being." 

Before  the  time  when  Greek  doctors  settled 
in   Eome,  medical   treatment  was   mainly    under 


EARLY  ROMAN   MEDICINE  7 

the  direct  charge  of  the  head  of  each  household. 
The  father  of  a  family  had  great  powers  conferred 
upon  him  by  the  Eoman  law,  and  was  physician  as 
well  as  judge  over  his  family.  If  he  took  his  new- 
born infant  in  his  arms  he  recognized  him  as  his 
son,  but  otherwise  the  child  had  no  claim  upon 
him.  He  could  inflict  the  most  dire  punishments 
on  members  of  his  household  for  which  they  had  no 
redress. 

Cato,  the  Elder,  who  died  in  B.C.  149,  wrote 
a  guide  to  domestic  medicine  for  the  use  of  Eoman 
fathers  of  the  Eepublic,  but  he  was  a  quack  and 
full  of  self-conceit.  He  hated  the  physicians 
practising  in  Eome,  who  were  mostly  Greeks,  and 
thought  that  their  knowledge  was  much  inferior  to 
his  own.  Plutarch  relates  that  Cato  knew  of  the 
answer  given  to  the  King  of  Persia  by  Hippocrates, 
when  sent  for  professionally,  "  I  will  never  make 
use  of  my  art  in  favour  of  barbarians  who  are 
enemies  of  the  Greeks,"  and  pretended  to  believe 
that  all  Greek  physicians  were  bound  by  the  same 
rule,  and  animated  by  the  same  motives.  However, 
Cato  did  a  great  deal  of  good  by  attempting  to 
lessen  the  vice  and  luxury  of  his  age. 

y'The  Greeks  in  Eome  were  looked  at  askance 
as  foreign  adventurers,  and  there  is  no  doubt  that 
although  many  were  honourable  men,  others  came 
to  Eome  merely  to  make  money  out  of  the  super- 
stitious beliefs  and  credulity  of  the  Eoman  peoplgj 
Fine   clothes,    a   good   house,    and   the   giving   of 


8  GREEK  AND  ROMAN  MEDICINE 

entertainments,  were  the  best  introduction  to 
practice  that  some  of  these  practitioners  could 
devise. 

The  medical  opinions  of  Cato  throw  a  sidelight 
upon  the  state  of  medicine  in  his  time.  He 
attempted  to  cure  dislocations  by  uttering  a 
nonsensical  incantation :  "  Huat  lianat  ista  yista 
sista  damiato  damnaustra  !  "  He  considered  ducks, 
geese  and  hares  a  light  and  suitable  diet  for  the 
sick,  and  had  no  faith  in  fasting. 

Although  the  darkness  was  prolonged  and  intense 
before  the  dawn  of  medical  science  in  Rome,  yet, 
in  ancient  times,  there  was  a  considerable  amount 
of  knowledge  of  sanitation.  The  great  sewer  of 
Eome,  the  Cloaca  Maxima,  which  drained  the 
swampy  valley  between  the  Capitoline  and  Palatine 
Hills,  was  built  by  order  of  Tarquinius  Prisons 
in  616  B.C.  It  is  wonderful  that  at  the  present 
time  the  visitor  may  see  this  ancient  work  in  the 
Eoman  Forum,  and  trace  its  course  to  the  Tiber. 
In  the  Forum,  too,  to  the  left  of  the  Temple  of 
Castor,  is  the  sacred  district  of  Juturna,  the  nymph 
of  the  healing  springs  which  well  up  at  the  base  of 
the  Palatine  Hill.  Lacus  Juturnce.  is  a  four-sided 
basin  with  a  pillar  in  the  middle,  on  which  rested  a 
marble  altar  decorated  with  figures  in  relief.  Beside 
the  basin  are  rooms  for  religious  purposes.  These 
rooms  are  adorned  with  the  gods  of  healing, 
^sculapius  with  an  acolyte  holding  a  cock,  the 
Dioscuri  and  their  horses,  the  head  of  Serapis,  and 
a  headless  statue  of  Apollo. 


EARLY   ROMAN   MEDICINE  9 

The  Cloaca  Maxima  was  formed  of  three  tiers 
of  arches,  the  vault  within  the  innermost  tier 
being  14  ft.  in  diameter.  The  administration  of 
the  sewers,  in  the  time  of  the  Eepublic,  was  in  the 
hands  of  the  censors,  but  special  officers  called 
curatores  cloacarum  were  employed  during  the 
Empire,  and  the  workmen  who  repaired  and 
cleansed  the  sewers  were  condemned  criminals. 
These  ancient  sewers,  which  have  existed  for 
twenty-five  centuries,  are  monuments  to  the 
wisdom  and  power  of  the  people  who  built  them. 
In  the  time  of  Furius  Camillus  private  drains 
were  connected  with  the  public  sewers  which 
were  flushed  by  aqueduct  and  rain  water.  This 
system  has  prevailed  throughout  the  centuries. 

The  Aqueducts  were  also  marvellous  works,  and 
although  they  were  added  to  in  the  time  of  the 
Empire,  Sextus  Julius  Frontinus,  curator  of  waters 
in  the  year  a.d.  94,  gives  descriptions  of  the  nine 
ancient  aqueducts,  some  of  which  were  con- 
structed long  before  the  Empire.  For  instance, 
the  Aqua  Appia  was  conducted  into  the  city  three 
hundred  and  twelve  years  before  the  advent  of 
Christ,  and  was  about  seven  miles  long.  The 
Aqua  Anio  Vetus,  sixty-two  miles  in  length,  built 
in  B.C.  144,  was  conveyed  across  the  Campagna 
from  a  source  in  the  country  beyond  Tivoli.  Near 
this  place  there  is  a  spring  of  milky-looking  water 
containing  sulphurous  acid,  sulphurated  lime,  and 
bicarbonate  of  lime,  used  now,  and  in  ancient  times 


10  GREEK  AND  ROMAN  MEDICINE 

for  the  relief  of  skin  complaints.  This  water,  at  the 
present  day,  has  an  almost  constant  temperature 
of  75°. 

In  course  of  time,  when  the  Eoman  power  was 
being  extended  abroad,  the  pursuit  of  conquest 
left  little  scope  for  the  cultivation  of  the  peaceful 
arts  and  the  investigation  of  science,  and  life  itself 
was  accounted  so  cheap  that  little  thought  was 
given  to  improving  methods  for  the  treatment  of 
the  sick  and  wounded.  On  a  campaign  every 
soldier  carried  on  his  person  a  field-dressing,  and 
the  wounded  received  rough-and-ready  first-aid 
attention  from  their  comrades  in  arms. 

Later,  when  conquest  was  ended,  and  attention 
was  given  to  the  consolidation  of  the  provinces, 
ease  and  happiness,  as  has  been  shown  by  Gibbon, 
tended  to  the  dec&j  of  courage  and  thus  to  lessen 
the  prowess  of  the  Eoman  legions,  but  there  was 
compensation  for  this  state  of  affairs  at  the  heart 
of  the  Empire  because  strong  streams  of  capable 
and  robust  recruits  flowed  in  from  Spain,  Gaul, 
Britain  and  Illyricum. 

At  its  commencement,  the  Empire  was  in  a 
peaceful,  and,  on  the  whole,  prosperous  condition, 
and  the  provincials,  as  well  as  the  Eomans, 
"  acknowledged  that  the  true  principles  of  social 
life,  laws,  agriculture,  and  science,  which  had  been 
first  invented  by  the  wisdom  of  Athens,  were  now 
firmly  established  by  the  power  of  Eome,  under 
whose  auspicious  influence  the  fiercest  barbarians 


EARLY  EOMAN   MEDICINE  11 

were  united  by  an  equal  government  and  common 
language.  They  affirm  that  with  the  improvement 
of  arts  the  human  species  was  visibly  multiplied. 
They  celebrate  the  increasing  splendour  of  the 
cities,  the  beautiful  face  of  the  country,  cultivated 
and  adorned  like  an  immense  garden ;  and  the  long 
festival  of  peace,  which  was  enjoyed  by  so  many 
nations,  forgetful  of  their  ancient  animosities,  and 
delivered  from  the  apprehension  of  future  danger." 
Thus  wrote  the  Eoman  historian,  and  Gibbon 
states  that  when  we  discount  as  much  of  this  as 
we  please  as  rhetorical  and  declamatory,  the  fact 
remains  that  the  substance  of  this  description  is 
in  accordance  with  the  facts  of  history.  Never 
until  the  Christian  era  was  any  thought  given 
to  the  regular  care  of  the  helpless  and  the  abject. 
Slaves  were  often  treated  like  cattle,  and  the 
patricians  had  no  bond  of  sympathy  with  the 
plebeians.  Provisions  were  sometimes  distributed 
to  the  poor,  and  taxes  remitted,  but  for  reasons 
of  State  and  not  from  truly  charitable  motives. 
Authority  was  also  given  to  parents  to  destroy 
new-born  infants  whom  they  could  not  support. 
The  idea  of  establishing  public  institutions  for 
the  relief  of  the  sick  and  the  poor  did  not  enter 
the  minds  of  the  ancient  Eomans. 

Before  considering  the  state  of  the  healing  art 
throughout  the  period  of  the  Eoman  Empire,  it 
is  necessary  to  devote  the  next  chapters  to  a 
consideration  of  the  rise  and  progress  of  medical 


12  GREEK  AND   ROMAN   MEDICINE 

science  in  Greece,  for  it  cannot  be  too  strongly 
emphasized  that  Eoman  philosophy  and  Eoman 
medicine  were  borrowed  from  the  G-reekSj  and  it 
is  certain  also  that  the  Greeks  were  indebted  to 
the  Egyptians  for  part  of  their  medical  knowledge. 
The  Bomans  were  distinguished  for  their  genius 
for  law-giving  and  government,  the  Greeks  for 
philosophy,  art,  and  mental  culture  generally. 


Plate  I.— BUST   OF  /ESCULAPIUS. 


13 


CHAPTEE   II. 
EAELY  GEEEK  MEDICINE. 

Apollo  —  ^sculapius — Temples — Serpents  —  Gods  of  Health 
— Melampus  —  Homer — Machaon — Podalarius — Temples 
of  ^sculapius  —  Methods  of  Treatment  —  Gymnasia  — 
Classification  of  Eenouard  —  Pythagoras  —  Democedes — 
Greek  Philosophers. 

The  history  of  healing  begins  in  the  Hellenic 
mythology  with  Apollo,  the  god  of  light  and  the 
promoter  of  health.  In  the  "Iliad"  he  is  hailed  as 
the  disperser  of  epidemics,  and,  in  this  respect,  the 
ancients  were  well  informed  in  attributing  destruc- 
tion of  infection  to  the  sun's  rays.  Chiron,  the 
Centaur,  it  was  believed,  was  taught  by  Apollo 
and  Artemis,  and  was  the  teacher,  in  turn,  of 
^sculapius,  who  probably  lived  in  the  thirteenth 
century  before  Christ  and  was  ultimately  deified  as 
the  Grreek  god  of  medicine.  Pindar  relates  of 
him : — 

"On  some  the  force  of  charmed  strains  he  tried, 
To  some  the  medicated  draught  applied ; 
Some  limbs  he  placed  the  amulets  around, 
Some  from  the  trunk  he  cut,  and  made  the  patient 
sound. "^ 

^sculapius  was  too  successful  in  his  art,  for  his 
death  was  attributed  to  Zeus,  who  killed  him  by  a 

^  Wheelwright's  translation  of  "Pindar." 


14  GREEK   AND   ROMAN    MEDICINE 

flash  of  lightning,  or  to  Pluto,  both  of  whom  were 
thought  to  have  feared  that  vEsculapius  might  by 
his  skill  gain  the  mastery  over  death. 

Amid  much  that  is  mythological  in  the  history 
of  ^sculapius,  there  is  a  groundwork  of  facts. 
Splendid  temples  were  built  to  him  in  lovely  and 
healthy  places,  usually  on  a  hill  or  near  a  spring ; 
they  were  visited  by  the  sick,  and  the  priests  of 
the  temples  not  only  attended  to  the  worship  of 
^sculapius,  but  took  pains  to  acquire  knowledge 
of  the  healing  art.  The  chief  temple  was  at 
Epidaurus,  and  here  the  patients  were  well 
provided  with  amusements,  for  close  to  the 
temple  was  a  theatre  capable  of  seating  12,000 
people,  and  a  stadium  built  to  accommodate  20,000 
spectators. 

A  serpent  entwined  round  a  knotted  staff  is  the 
symbol  of  ^sculapius.  A  humorist  of  the  present 
day  has  suggested  that  the  knots  on  the  staff 
indicate  the  numerous  "  knotty  "  questions  which 
a  doctor  is  asked  to  solve !  Tradition  states  that 
when  jEsculapius  was  in  the  house  of  his  patient, 
Glaucus,  and  deep  in  thought,  a  serpent  coiled 
itself  around  his  staff,  ^sculapius  killed  it,  and 
then  another  serpent  appeared  with  a  herb  leaf 
in  its  mouth,  and  restored  the  dead  reptile  to  life. 
It  seems  probable  that  disease  was  looked  upon 
as  a  poison.  Serpents  produced  poison,  and  had  a 
reputation  in  the  most  ancient  times  for  wisdom, 
and  for  the  power  of  renovation,  and  it  was  thought 


From  Wellcome  s   Medical  Diary- (Copyright) 
By  pennission  of  Burroughs   Wellcome  8c  Go 


Plate  II.— HYGEIA 
The  Greek  Deity  of  Health. 


EARLY  GREEK  MEDICINE  15 

that  a  creature  which  could  produce  poison  and 
disease  might  probably  be  capable  of  curing  as  well 
as  killing.  Serpents  were  kept  in  the  Temples  of 
^sculapius,  and  were  non-poisonous  and  harmless. 
They  were  given  their  liberty  in  the  precincts 
of  the  temple,  but  were  provided  with  a  serpent- 
house  or  den  near  to  the  altar.  They  were  wor- 
shipped as  the  incarnation  of  the  god,  and  were 
fed  by  the  sick  at  the  altar  with  "popana,"  or 
sacrificial  cakes. 

Many  of  the  Greek  gods  and  goddesses  were  held 
to  have  power  over  disease.  Hygeia,  known  as 
Salus  to  the  Eomans,  was  said  to  have  been  the 
daughter  of  ^sculapius,  and  to  have  taken  care  of 
the  sacred  serpents  (Plate  II). 

Melampus  was  considered  by  the  Greeks  the 
first  mortal  to  practise  healing.  In  one  case  he 
prescribed  rust,  probably  the  earliest  use  of  iron 
as  a  drug,  and  he  also  used  hellebore  root  as  a 
purgative.  He  married  a  princess  and  was  given 
part  of  a  kingdom  as  a  reward  for  his  services. 
After  his  death  he  was  awarded  divine  honours,  and 
temples  were  erected  for  his  worship.  The  deifica- 
tion of  ^sculapius  and  of  Melampus  added  much 
to  the  prestige  of  doctors  in  Greece,  where  they 
were  always  held  in  honour;  but  in  Eome  the 
practice  of  medicine  was  not  considered  a  highly 
honourable  calling. 

Something  can  be  learned  from  the  writings  of 
Homer   of    the   state    of    medicine    in    his   time, 


16  .  GREEK  AND   ROMAN   MEDICINE 

although  we  need  hardly  expect  to  find  in  an  epic 
poem  many  references  to  diseases  and  their  cure. 
As  dissection  was  considered  a  profanation  of 
the  body,  anatomical  knowledge  was  exceedingly 
meagre.  Machaon  was  surgeon  to  Menelaus 
and  Podalarius  was  the  pioneer  of  phlebotomy. 
Both  were  regarded  as  the  sons  of  ^sculapius; 
they  were  soldiers  as  well  as  doctors,  and 
fought  before  the  walls  of  Troy.  The  surgery 
required  by  Homer's  heroes  was  chiefly  that  of  the 
battlefield.  Unguents  and  astringents  were  in 
use  in  the  physician's  art,  and  there  is  reference  to 
"  nepenthe,"  a  narcotic  drug,  and  also  to  the  use  of 
sulphur  as  a  disinfectant.  Doctors,  according  to 
Homer,  were  held  in  high  esteem,  and  Arctinus 
relates  that  two  divisions  were  recognized,  surgeons 
and  physicians,  the  former  held  in  less  honour  than 
the  latter — "  Then  Asclepius  (^sculapius)  bestowed 
the  power  of  healing  upon  his  two  sons  ;  neverthe- 
less, he  made  one  of  the  two  more  celebrated  than 
the  other ;  on  one  did  he  bestow  the  lighter  hand 
that  he  might  draw  missiles  from  the  flesh,  and 
sew  up  and  heal  all  wounds;  but  the  other  he 
endowed  with  great  precision  of  mind,  so  as  to 
understand  what  cannot  be  seen,  and  to  heal 
seemingly  incurable  diseases."^ 

Machaon  fought  in  the  army  of  Nestor.     Fearing 


1  Arctinus,  "  Ethiopis."  Translated  in  Puschmann's  "  Hist. 
Med.  Education." 


EARLY   GREEK  MEDICINE  17 

for  his  safety,  King  Idomeneus  placed  him  under 
the  charge  of  Nestor,  who  was  instructed  to  take 
the  doctor  into  his  chariot,  for  "a  doctor  is  worth 
many  men."  When  Menelaus  was  wounded,  a 
messenger  was  sent  for  Machaon,  who  extracted  the 


Froin  Wellcome' s  Medical  Diary  (Copyright) 
By  permission  of  Burroughs  Wellcome  &  Co. 


Machaon  (Son  of  Asklepios), 
The  first  Greek  military  surgeon,  attending  to  the  wounded  Menelaus. 

barbed   arrow,    sucked   the   wound   and  apphed  a 

secret   ointment   made  known   to   ^sculapius   by 

Chiron  the  Centaur,  according  to  tradition. 

The  practice  of  Greek  medicine  became  almost 

entirely  restricted  to  the  temples  of  ^sculapius. 

the   most   important   of  which  were   situated   at 

Ehodes,     Cnidus    and    Cos.      The    priests    were 
2 


18  GREEK  AND   ROMAN   MEDICINE 

known  as  Asclepiadse,  but  the  name  was 
applied  in  time  to  the  healers  of  the  temple 
who  were  not  priests.  Tablets  were  affixed  to  the 
walls  of  these  temples  recording  the  name  of  the 
patient,  the  disease  and  the  cm-e  prescribed.  There 
is  evidence  that  diseases  were  closely  observed. 
The  patients  brought  gifts  to  the  temples,  and 
underwent  a  preliminary  purification  by  ablutions, 
fasting,  prayer  and  sacrifice.  A  cock  was  a 
common  sacrifice  to  the  god.  No  doubt  many 
wonderful  cures  were  effected.  Mental  sugges- 
tion was  used  greatly,  and  the  patient  was  put 
to  sleep,  his  cure  being  often  revealed  to  him 
in  a  dream  which  was  interpreted  by  the  priests. 
The  expectancy  of  his  mind,  and  the  reduced  state 
of  his  body  as  the  result  of  abstinence  conduced  to 
a  cure,  and  trickery  also  played  a  minor  part. 
Albeit,  much  of  the  treatment  prescribed  was 
commendable.  Pure  air,  cheerful  surroundings, 
proper  diet  and  temperate  habits  were  advocated, 
and,  among  other  methods  of  treatment,  exercise, 
massage,  sea-bathing,  the  use  of  mineral  waters, 
purgatives  and  emetics,  and  hemlock  as  a  sedative, 
were  in  use.  If  a  cure  was  not  effected,  the  faith 
of  the  patient  was  impugned,  and  not  the  power 
of  the  god  or  the  skill  of  the  Asclepiades,  so  that 
neither  religion  nor  the  practice  of  physic  was 
exposed  to  discredit.  Great  was  the  wisdom  of 
the  Greeks !  These  temples  were  the  famous 
medical   schools   of   ancient    Greece.     A   spirit  of 


EAELY  GREEK  MEDICINE  19 

emulation  prevailed,  and  a  high  ethical  standard 
was  attained,  as  is  shown  by  the  oath  prescribed 
for  students  when  they  completed  their  course 
of  study.  The  form  of  oath  will  be  found  in  a 
succeeding  chapter  in  connection  with  an  account 
of  the  life  of  Hippocrates. 

The  remains  of  the  Health  Temple,  or  Askle- 
pieion,  of  Cos  were  brought  to  light  in  1904  and 
1905,  by  the  work  of  Dr.  Eudolf  Herzog,  of 
Tubingen.  Dr.  Eichard  Caton,  of  Liverpool,  has 
been  able  to  reconstruct  pictorially  the  beautiful 
buildings  that  existed  two  thousand  years  ago. 
They  were  situated  among  the  hills.  The  sacred 
groves  of  cypresses  were  on  three  sides  of  the 
temple,  and  "  to  the  north  the  verdant  plain  of 
Cos,  with  the  white  houses  and  trees  of  the  town 
to  the  right,  and  the  wide  expanse  of  turquoise  sea 
dotted  by  the  purple  islands  of  the  ^^gean,  and 
the  dim  mountains  about  Halicarnassus,  to  the 
north-east."^ 

The  ancient  Greek  Gymnasia  were  in  use  long 
before  the  Asclepiades  began  to  practise  in  the 
temples.  The  Greeks  were  a  healthy  and  strong 
race,  mainly  because  they  attended  to  physical 
culture  as  a  national  duty.  The  attendants 
who  massaged  the  bodies  of  the  athletes  were 
called  aliptcs,  and  they  also  taught  physical  exer- 
cises, and  practised  minor  surgery  and  medicine. 

1  Caton,  Brit.  Med.  Journ.,  1906,  i,  p.  571. 


20  GREEK  AND   ROMAN   MEDICINE 

Massage  was  used  before  and  after  exercises  in  the 
gymnasium,  and  was  performed  by  anointing  the 
body  with  a  mixture  of  oil  and  sand  which  was 
well  rubbed  into  the  skin.  There  were  three 
classes  of  officials  in  the  gymnasia;  the  director 
or  magistrate  called  the  gymnasiarcli,  the  sub- 
director  or  gijmnast,  and  the  subordinates.  The 
directors  regulated  the  diet  of  the  young  men,  the 
sub-directors,  besides  other  duties,  prescribed  for  the 
sick,  and  the  attendants  massaged,  bled,  dressed 
wounds,  gave  clysters,  and  treated  abscesses,  dis- 
locations, &c. 

There  is  no  doubt  that  the  Grreeks,  in  insisting 
upon  the  physical  training  of  the  young,  were  wiser 
in  their  generation  than  the  people  of  the  present 
day  ;  and  not  only  the  young,  but  people  of  mature 
age,  took  exercises  suited  to  their  physical  require- 
ments. The  transgression  of  some  of  Solon's  laws 
in  reference  to  the  gymnasia  was  punishable  by 
death. 

The  third  stage  in  the  history  of  Greek  medicine 
has  now  been  reached.  The  first  stage  was  primi- 
tive, the  second  associated  with  religion,  and 
the  third  connected  with  philosophy.  The  clas- 
sification of  Renouard  is  accurate  and  convenient. 
In  the  "Age  of  Foundation,"  he  recognizes  four 
periods,  namely : — 

(1)  The  Primitive  Period,  or  that  of  Instinct, 
beginning  with  myth,  and  ending  with  the  destruc- 
tion of  Troy,  1184  years  before  Christ. 


EAELY  GEEEK  MEDICINE  21 

(2)  The  Sacred  or  Mystic  Period,  ending  with 
the  dispersion  of  the  Pythagorean  Society,  500 
years  before  Christ. 

(3)  The  Philosophic  Period,  ending  with  the 
foundation  of  the  Alexandrian  library,  320  years 
before  Christ.  This  period  is  made  illustrious  by 
Hippocrates. 

(4)  The  Anatomic  Period,  ending  with  the  death 
of  Galen,  about  200  years  after  Christ. 

The  earliest  Greek  medical  philosopher  was 
Pythagoras  (about  580  B.C.).  He  was  born  at 
Samos,  and  began  life  as  an  athlete,  but  a  lecture 
which  he  heard  on  the  subject  of  the  immortality 
of  the  soul  kindled  enthusiasm  for  philosophical 
study,  the  pursuit  of  which  led  him  to  visit  Egypt, 
Phoenicia,  Chaldea,  and  perhaps  also  India.  He 
was  imbued  with  Eastern  mysticism,  and  held 
that  the  air  is  full  of  spiritual  beings  who  send 
dreams  to  men,  and  health  or  disease  to  mankind 
and  to  the  lower  animals.  Pie  did  not  remain  long 
in  Greece,  but  travelled  much,  and  settled  for  a 
considerable  time  in  Crotona,  in  the  South  of 
Italy,  where  he  taught  pupils,  their  course  of  study 
extending  over  five  or  six  years.  The  Pythagorean 
Society  founded  by  him  did  much  good  at  first, 
but  its  members  ultimately  became  greedy  of  gain 
and  dishonest,  and  the  Society  in  the  lifetime  of 
its  founder  was  subjected  to  persecution  and  dis- 
persed by  angry  mobs.  Pythagoras  possessed  a 
prodigious  mind.     He  is  best  known  for  his  teaching 


22  GREEK  AND  ROMAN  MEDICINE 

in  reference  to  the  transmigration  of  souls,  but  he 
was  also  a  great  mathematician  and  astronomer. 
He  taught  that  "  number  is  the  essence  of  every- 
thing," and  his  philosophy  recognized  that  the 
universe  is  governed  by  law.  God  he  represented 
by  the  figure  1,  matter  by  the  figure  2,  and  the 
universe  by  the  combination  12,  all  of  which, 
though  fanciful,  was  an  improvement  upon  mytho- 
logy, and  a  recognition  of  system. 

In  the  practice  of  medicine  he  promoted  health 
mainly  by  diet  and  gymnastics,  advised  music  for 
depression  of  spirits,  and  had  in  use  various 
vegetable  drugs.  He  introduced  oxymel  of  squills 
from  Egypt  into  Greece,  and  was  a  strong  believer 
in  the  medicinal  properties  of  onions.  He  viewed 
surgery  with  disfavour,  and  used  only  salves  and 
poultices.  The  Asclepiades  treated  patients  in  the 
temples,  but  the  Pythagoreans  visited  from  house 
to  house,  and  from  city  to  city,  and  were  known 
as  the  ambulant  or  periodic  physicians. 

Herodotus  gives  an  account  of  another  eminent 
physician  of  Crotona,  Democedes  by  name,  who 
succeeded  Pythagoras.  At  this  time,  it  is  recorded 
that  the  various  cities  had  public  medical  officers. 
Democedes  gained  his  freedom  from  slavery  as  a 
reward  for  curing  the  wife  of  Darius  of  an  abscess 
in  the  breast. 

The  dispersal  of  the  Pythagoreans  led  to  the 
settlement  of  many  of  them,  and  of  their  imitators^ 
in   Eome   and  various  parts   of  Italy.     Although 


EAELT  GEEEK  MEDICINE  23 

Pythagoras  was  a  philosopher,  he  belongs  to  the 
Mystic  Period,  while  Hippocrates  is  the  great 
central  figure  of  the  Philosophic  Period.  Before 
studying  the  work  of  Hippocrates,  it  is  necessary 
to  consider  the  distinguishing  features  of  the 
various  schools  of  Greek  philosophy.  Eenouard 
shows  that  the  principles  of  the  various  schools 
of  medical  belief  depended  upon  the  three  great 
Greek  schools  of  Cosmogony. 

Pythagoras  believed  in  a  Supreme  Buler  of  the 
Universe,  and  that  spirits  animated  all  life,  and 
existed  even  in  minerals ;  he  also  believed  in 
preconceived  purpose.  With  these  views  were 
associated  the  Dogmatic  School  of  Medicine,  and 
the  name  of  Hippocrates,  and  this  belief  corresponds 
to  modern  vitalism. 

Leucippus  and  Democritus,  rejecting  theology, 
considered  vital  action  secondary  to  the  operation 
of  the  laws  of  matter,  and  believed  that  atoms 
moved  through  pores  in  the  body  in  such  a  way  as 
to  determine  a  state  of  health  or  disease.  With 
this  philosophy  was  associated  the  Medical  School 
of  Methodism,  a  system  said  to  have  been  founded 
by  Asclepiades  of  Prusa  (who  lived  in  Eome  in  the 
first  century  before  Christ),  and  by  his  pupil 
Themison  (b.c.  50).  The  third  school  of  medical 
thought,  that  of  Empiricism,  taught  that  experi- 
ence was  the  only  teacher,  and  that  it  was  idle  to 
speculate  upon  remote  causes.  The  Empirics 
based  these  views  upon  the  teaching  of  philosophers 


24  GEEEK  AND   ROMAN   MEDICINE 

known  as  Sceptics  or  Zetetics,  followers  of  Par- 
menides  and  Pyrrho,  who  taught  that  it  was  useless 
to  fatigue  the  mind  in  endeavouring  to  comprehend 
what  is  beyond  its  range.  They  were  the  pre- 
cursors of  modern  agnosticism. 

The  Eclectics,  in  a  later  age,  formed  another 
medical  sect,  and  had  no  definite  system  except 
that  they  made  a  selection  of  the  views  and 
methods  of  Dogmatists,  Methodists  and  Empirics. 

The  Greek  philosophers  as  a  class  believed  in 
a  primary  form  of  matter  out  of  which  elements 
were  formed,  and  the  view  held  in  regard  to  the 
elements  is  expressed  in  Ovid's  "  Metamorphoses."^ 

"Nor  those  which  elements  we  call  abide, 
Nor  to  this  figure  nor  to  that  are  ty'd : 
For  this  eternal  world  is  said  of  old 
But  four  prolific  principles  to  hold, 
Pour  different  bodies  ;  two  to  heaven  ascend, 
And  other  two  down  to  the  centre  tend. 
Fire  first,  with  wings  expanded,  mounts  on  high, 
Pure,  void  of  weight,  and  dwells  in  upper  sky ; 
Then  air,  because  unclogged,  in  empty  space 
Flies  after  fire,  and  claims  the  second  place  ; 
But  weighty  water,  as  her  nature  guides, 
Lies  on  the  lap  of  earth ;  and  Mother  Earth  subsides. 
All  things  are  mixed  of  these,  which  all  contain, 
And  into  these  are  all  resolved  again." 

Fire  was  considered  to  be  matter  in  a  very 
refined  form,  and  to  closely  resemble  life  or  even 
soul. 


^  Dryden's  translation,  book  xv. 


25 


CHAPTEE  III. 

HIPPOCEATES. 

His  life  and  works — His  influence  on  Medicine. 

Hippocrates,  the  Father  of  Medicine,  was  born  at 
Cos  during  the  golden  age  of  Greece,  460  years  before 
Christ.  He  belonged  to  the  family  of  the  Ascle- 
piadse,  and,  according  to  tradition,  could  trace  his 
ancestors  on  the  male  side  to  ^sculapius,  and  on 
the  female  side  to  Hercules.  He  is  said  to  have 
received  his  medical  education  from  his  father  and 
from  Herodicus,  and  to  have  been  taught  philosophy 
by  Gorgias,  the  Sophist,  and  by  Democritus,  whom 
he  afterwards  cured  of  mental  derangement. 

There  was  a  very  famous  medical  school  at  Cos, 
and  the  temple  there  held  the  notes  of  the  accumu- 
lated experience  of  his  predecessors,  but  Hippocrates 
visited  also,  for  the  purpose  of  study,  various  towns 
of  Greece,  and  particularly  Athens.  He  was  a 
keen  observer,  and  took  careful  notes  of  his  observa- 
tions. His  reputation  was  such  that  his  works 
are  quoted  by  Plato  and  by  Aristotle,  and  there 
are  references  to  him  by  Arabic  writers.  His 
descendants  published  their  own  writings  under 
his  name,  and  there  were  also  many  forgeries,  so 
that  it  is  impossible  to  know  exactly  how  many  of 


26  GREEK  AND   ROMAN   MEDICINE 

the  works  attributed  to  him  are  authentic ;  but  by 
a  consensus  of  opinion  the  following  books  are 
considered  genuine  :  "  Prognostics,"  seven  of  the 
books  of  "  Aphorisms,"  "  On  Airs,  Waters  and 
Places,"  "  On  Begimen  in  Acute  Diseases,"  the 
first  and  third  books  of  "  Epidemics,"  "  On  the 
Articulations,"  "  On  Fractures,"  the  treatise  on 
"Instruments  of  Reduction,"  and  "The  Oath"; 
and  the  books  considered  almost  certainly  genuine 
are  those  dealing  with  "  Ancient  Medicine," 
"Surgery,"  "The  Law,"  "Fistula,"  "Ulcers," 
"Haemorrhoids,"  and  "On  the  Sacred  Disease" 
(Epilepsy).  The  famous  Hippocratic  Collection 
in  the  great  libraries  of  Alexandria  and  Pergamos 
also  comprised  the  writings  of  Pythagoras,  Plato 
and  Aristotle. 

The  genius  of  Hippocrates  is  unsurpassed  in 
the  history  of  medicine.  He  was  the  first  to 
trace  disease  to  a  natural  and  intelligible  cause, 
and  to  recognize  Nature  as  all-sufficient  for  heal- 
ing, and  physicians  as  only  her  servants.  He  dis- 
cussed medical  subjects  freely  and  without  an  air 
of  mystery,  scorning  all  pretence,  and  he  was 
also  courageous  enough  to  acknowledge  his  limit- 
ations and  his  failures.  When  the  times  in  which 
he  lived  are  considered,  it  is  difficult  to  know  which 
of  his  qualities  to  admire  most,  his  love  of  know- 
ledge, his  powers  of  observation,  his  logical  faculty, 
or  his  courage  and  truthfulness. 

The  central  principle  of  belief  of  Hippocrates  and 


HIPPOCEATES  27 

the  Dogmatists  was  that  health  depended  on  the 
proper  proportion  and  action  in  the  body  of  the 
four  elements,  earth,  water,  air,  and  fire,  and  the 
four  cardinal  humours,  blood,  phlegm,  yellow 
bile  and  black  bile.  The  due  combination  of 
these  was  known  as  crasis,  and  existed  in  health. 
If  a  disease  were  progressing  favourably  these 
humours  became  changed  and  combined  (coction), 
preparatory  to  the  expulsion  of  the  morbid  matter 
(crisis),  which  took  place  at  definite  periods  known 
as  critical  days.  Hippocrates  also  held  the  theory 
of  fluxions,  which  were  conditions  in  the  nature  of 
congestion,  as  it  would  now  be  understood. 

In  his  time  public  opinion  condemned  dissection 
of  the  human  body,  but  it  is  certain  that  dissections 
were  performed  by  Hippocrates  to  a  limited  extent. 
He  did  not  know  the  difference  between  the  arteries 
and  the  veins,  and  nerves  and  ligaments  and  various 
membranes  were  all  thought  to  have  analogous 
functions,  but  his  writings  display  a  correct  know- 
ledge of  the  anatomy  of  certain  parts  of  the  body 
such  as  the  joints  and  the  brain.  This  defective 
knowledge  of  anatomy  gave  rise  to  fanciful  views 
on  physiology,  which,  among  much  that  is  admir- 
able, disfigure  the  Hippocratic  writings. 

The  belief  that  almost  all  medical  and  surgical 
knowledge  is  modern,  though  flattering  to  our 
self-complacency,  is  disturbed  by  the  study  of  the 
state  of  knowledge  in  the  time  of  Hippocrates. 
To  him  we  are   indebted  for  the  classification  of 


28  GEEEK  AND   EOMAN   MEDICINE 

diseases  into  sporadic,  epidemic,  and  endemic,  and 
he  also  separated  acute  from  chronic  diseases. 
He  divided  the  causes  of  disease  into  two  classes : 
general,  such  as  climate,  water  and  sanitation; 
and  personal,  such  as  improper  food  and  neglect 
of  exercise. 

He  based  his  conclusions  on  the  observation  of 
appearances,  and  in  this  way  began  a  new  era.  He 
was  so  perfect  in  the  observation  of  external  signs 
of  disease  that  he  has  never  in  this  respect  been 
excelled.  The  state  of  the  face,  eyes,  tongue, 
voice,  hearing,  abdomen,  sleep,  breathing,  excre- 
tions, posture  of  the  body,  and  so  on,  all  aided  him 
in  diagnosis  and  prognosis,  and  to  the  latter 
he  paid  special  attention,  saying  that  "  the  best 
physician  is  the  one  who  is  able  to  establish  a 
prognosis,  penetrating  and  exposing  first  of  all, 
at  the  bedside,  the  present,  the  past,  and  the  future 
of  his  patients,  and  adding  what  they  omit  in  their 
statements.  He  gains  their  confidence,  and  being 
convinced  of  his  superiority  of  knowledge  they  do 
not  hesitate  to  commit  themselves  entirely  into  his 
hands.  He  can  treat,  also,  so  much  better  their 
present  condition  in  proportion  as  he  shall  be  able 
from  it  to  foresee  the  future." 

He  wrote  about  the  history  of  Medicine,  a  study 
which  is  much  neglected  at  the  present  time. 
There  is  no  generation  of  men  so  wise  that  they 
cannot  with  advantage  adopt  some  ideas  from  the 
remote  past,  or,  at  least,  find  the  teaching  of  their 


HIPPOCRATES  29 

predecessors  suggestive.  Hippocrates  was  one  of 
the  first  to  recognize  the  vis  viedicatrix  natuns,  and 
he  always  aimed  at  assisting  Nature.  His  style 
of  treatment  would  be  known  now  as  expectant, 
and  he  tried  to  order  his  practice  "to  do  good,  or, 
at  least,  to  do  no  harm."  When  he  considered 
interference  necessary,  however,  he  did  not  hesi- 
tate even  to  apply  drastic  measures,  such  as  scari- 
fication, cupping  and  bleeding.  He  made  use  of 
the  narcotics  mandragora,  henbane,  and  probably 
also  poppy-juice,  and  as  a  laxative  used  greatly 
a  vegetable  substance  called  "  mercury,"  beet  and 
cabbage,  and  cathartics  such  as  scammony  and 
elaterium !  He  was  able  to  diagnose  fluid  in  the 
chest  or  abdomen  by  means  of  percussion  and 
auscultation,  and  to  withdraw  the  fluid  by  the 
operation  of  paracentesis,  and  he  recognized  also 
that  the  fluid  should  be  allowed  to  flow  away 
slowly  so  as  to  minimize  the  risk  of  syncope.  He 
operated  also  for  empyema.  In  regard  to  the 
methods  of  Hippocrates  for  the  physical  examina- 
tion of  the  chest  it  is  reasonable  to  suppose  that 
the  Father  of  Medicine  indirectly  inspired  Laennec 
to  invent  the  stethoscope.  Hippocrates  prescribed 
fluid  diet  for  fevers,  allowed  the  patients  cold 
water  or  barley  water  to  drink,  and  recommended 
cold  sponging  for  high  fever.  In  his  writings  will 
be  found  his  views  on  apoplexy,  epilepsy,  phthisis, 
gout,  erysipelas,  cancer  and  many  other  diseases, 
common  at  the  present  day. 


30  GKEEK  AND   ROMAN   MEDICINE 

In  the  province  of  Surgery,  Hippocrates  was 
surprisingly  proficient,  although  he  lived  before 
the  Anatomic  Period.  He  had  various  lotions 
for  the  healing  of  ulcers ;  some  of  these  lotions 
were  antiseptic  and  have  been  in  use  in  recent 
times.  His  opinions  on  the  treatment  of  fractures 
are  sound,  and  he  was  a  master  in  the  use  of  splints, 
and  considered  that  it  was  disgraceful  on  the  part 
■of  the  surgeon  to  allow  a  broken  limb  to  set  in  a 
faulty  position.  He  resected  the  projecting  ends 
of  the  bone  in  the  case  of  compound  fracture.  He 
had  a  very  complete  knowledge  of  the  anatomy  of 
joints,  was  well  acquainted  with  hip- joint  disease, 
and  could  operate  upon  joints.  Accidents  were  no 
doubt  common  in  the  gymnasia,  and  practice  in 
the  treatment  of  fractures  and  dislocations  exten- 
sive and  of  a  high  order  of  excellence.  Hippocrates 
used  the  sound  for  exploring  the  bladder,  and 
understood  the  use  of  the  speculum  for  examin- 
ing the  rectum,  and  in  operations  for  fistula  and 
piles.  He  understood  the  causation  of  club-foot, 
and  could  cure  cases  of  this  deformity  by  bandag- 
ing. He  was  skilful  also  in  obstetric  operations. 
He  trepanned  the  skull,  which  appears  to  have 
heen  a  common  operation  in  his  day.  He  had 
clear  and  sound  views  in  reference  to  wounds  of 
the  head,  recognizing  that  trivial-looking  wounds 
of  the  scalp  might  become  very  serious.  Hippo- 
crates gave  directions  as  to  the  indications  for 
using  the  trepan,  and  warned  the  operator  against 


HIPPOCBATES  31 

mistaking     sutures     of     the     cranial     bones     for 
fracture. 

He  did  not  describe  amputations  as  generally 
understood,  but  removed  limbs  at  a  joint  for  gan- 
grene. When  necessary  he  made  use  of  mechanical 
appliances  for  reducing  dislocations,  and  recom- 
mended doctors  to  furnish  their  surgeries  with  an 
adjustable  table,  fitted  with  levers,  for  dealing  with 
the  reduction  of  dislocations,  and  for  various  other 
surgical  manipulations.  Excision  of  tumours  was 
not  a  common  operation  of  Hippocratic  surgery, 
although  it  had  been  a  part  of  Hindu  practice  in 
very  ancient  times.  On  the  subject  of  Obstetrics, 
Hippocrates  wrote  a  great  deal,  and  although  many 
of  his  theories  seem  absurd  at  the  present  day,  yet, 
on  the  whole,  the  treatment  he  recommends  is 
efficacious.  Eegarding  Gyncscology,  in  his  treatise 
on  "Airs,  Water  and  Places,"  it  is  interesting  to 
observe  that  he  says  that  the  drinking  of  impure 
water  will  cause  dropsy  of  the  uterus.  Adams, 
commenting  on  this,  has  in  mind  hydatids,  but  it 
is  evident  that  both  Hippocrates  and  his  translator 
and  critic  have  mistaken  hydatidiform  disease  of 
the  ovum  for  hydatid  disease  of  the  womb.  In  the 
books  which  are  considered  genuine  the  references 
to  diseases  of  women  are  meagre,  and  it  is  likely 
that  the  author  had  little  special  knowledge  of  the 
subject.  That  part  of  the  Hippocratic  collection 
which  is  not  considered  genuine  deals  rather  fully 


32  GREEK  AND   ROMAN   MEDICINE 

with  the  subject  of  gynaecology/  In  it  are  de- 
scribed sounds  made  of  wood  and  of  lead,  dilators 
and  uterine  catheters,  Sitz  baths  were  in  use, 
and  fumigations  were  very  extensively  employed 
in  gynaecological  practice.  Pessaries  were  made 
by  rolling  lint  or  wool  into  an  oblong  shape,  and 
were  medicated  to  be  emollient,  astringent  or 
purgative  in  their  local  action.  The  half  of  a 
pomegranate  was  used  as  a  mechanical  pessary, 
and  there  are  also  references  to  tents,  and  to 
suppositories  for  the  bowel. 

In  dealing  with  Dietetics,  Hippocrates  displays 
close  observation  and  sound  judgment.  The  views 
held  generally  at  the  present  day  coincide  closely 
with  his  instructions  on  food  and  feeding.  In  the 
treatise  on  Ancient  Medicine,  he  states  that  men 
had  to  find  from  experience  the  properties  of 
various  vegetable  foods,  and  discovered  that  what 
was  suitable  in  health  was  unsuitable  in  sickness, 
and  that  the  accumulation  of  these  discoveries  was 
the  origin  of  the  art  of  medicine. 

The  Sydenham  Society  initiated,  and  Dr.  Adams 
brilliantly  accomplished,  a  noble  work  in  the  publi- 
cation in  1849  of  "  The  Genuine  Works  of  Hippo- 
crates," from  which  "  The  Law,"  and  "  The  Oath  " 
are  here  quoted.  The  former  is  the  view  of  Hippo- 
crates  of  the  standards  which  should  govern  the 


^  Vide  "History  of  GynsBcology,"  by  W.  J.  Stewart  McKay. 
Bailliere,  Tindall  and  Cox,  1901. 


HIPPOCEATES  33 

practice  of  medicine;  the  latter  is  that  by  which 
all  the  ^sculapians  were  bound. 

"  The  Law. 

"  (1)  Medicine  is  of  all  the  arts  the  most  noble ; 
but,  owing  to  the  ignorance  of  those  who  practise 
it,  and  of  those  who,  inconsiderately,  form  a  judg- 
ment of  them,  it  is  at  present  far  behind  all  the 
other  arts.  Their  mistake  appears  to  me  to  arise 
principally  from  this,  that  in  the  cities  there  is  no 
punishment  connected  with  the  practice  of  medi- 
cine (and  with  it  alone)  except  disgrace,  and  that 
does  not  hurt  those  who  are  familiar  with  it. 
Such  persons  are  like  the  figures  which  are  in- 
troduced in  tragedies,  for  as  they  have  the  shape, 
and  dress,  and  personal  appearance  of  an  actor, 
but  are  not  actors,  so  also  physicians  are  many  in 
title  but  very  few  in  reality. 

"  (2)  Whoever  is  to  acquire  a  competent  know- 
ledge of  medicine,  ought  to  be  possessed  of  the 
following  advantages  :  A  natural  disposition ;  in- 
struction ;  a  favourable  position  for  the  study  ;  early 
tuition ;  love  of  labour ;  leisure.  First  of  all,  a 
natural  talent  is  required,  for,  when  Nature  opposes, 
everything  else  is  vain ;  but  when  Nature  leads  the 
way  to  what  is  most  excellent,  instruction  in  the 
art  takes  place,  which  the  student  must  try  to 
appropriate  to  himself  by  reflection,  becoming  an 
early  pupil  in  a  place  well  adapted  for  instruction. 


34  GEEEK  AND   BOMAN   MEDICINE 

He  must  also  bring  to  the  task  a  love  of  labour 
and  perseverance,  so  that  the  instruction  taking 
root  may  bring  forth  proper  and  abundant  fruits. 

"  (3)  Instruction  in  medicine  is  like  the  culture 
of  the  productions  of  the  earth.  For  our  natural 
disposition  is,  as  it  were,  the  soil ;  the  tenets  of 
our  teacher  are,  as  it  were,  the  seed;  instruction 
in  youth  is  like  the  planting  of  the  seed  in  the 
ground  at  the  proper  season ;  the  place  where  the 
instruction  is  communicated  is  like  the  food  im- 
parted to  vegetables  by  the  atmosphere;  diligent 
studv  is  like  the  cultivation  of  the  fields ;  and  it  is 
time  which  imparts  strength  to  all  things  and 
brings  them  to  maturity. 

"  (4)  Having  brought  all  these  requisites  to  the 
study  of  medicine,  and  having  acquired  a  true 
knowledge  of  it,  we  shall  thus,  in  travelling 
through  the  cities,  be  esteemed  physicians  not 
only  in  name  but  in  reality.  But  inexperience  is 
a  bad  treasure,  and  a  bad  friend  to  those  who 
possess  it,  whether  in  opinion  or  reality,  being 
devoid  of  self-reliance  and  contentedness,  and  the 
nurse  both  of  timidity  and  audacity.  For  timidity 
betrays  a  want  of  powers,  and  audacity  a  want  of 
skill.  There  are,  indeed,  two  things,  knowledge 
and  opinion,  of  which  the  one  makes  its  possessor 
really  to  know,  the  other  to  be  ignorant. 

"  (5)  These  things  which  are  sacred  are  to  be 
imparted  only  to  sacred  persons ;  and  it  is  not 
lawful    to    impart    them    to    the    profane    until 


HIPPOCEATES  35 

they  have  been  initiated  in  the  mysteries  of  the 
science." 

"The  Oath. 

"  I  swear  by  Apollo,  the  physician,  and  ^scul- 
apius,  and  Health,  and  Panacea,  and  all  the  gods 
and  goddesses,  that,  according  to  my  ability  and 
judgment,  I  will  keep  this  oath  and  this  stipula- 
tion —  to  reckon  him  who  taught  me  this  art 
equally  dear  to  me  as  my  parents,  to  share  my 
substance  with  him,  and  relieve  his  necessities  if 
required;  to  look  upon  his  offspring  in  the  same 
footing  as  my  own  brothers,  and  to  teach  them 
this  art,  if  they  shall  wish  to  learn  it,  without  fee 
or  stipulation;  and  that  by  precept,  lecture,  and 
every  "other  mode  of  instruction,  I  will  impart  a 
knowledge  of  the  Art  to  my  own  sons,  and  those 
of  my  teachers,  and  to  disciples  bound  by  a  stipu- 
lation and  oath  according  to  the  law  of  medicine, 
but  to  none  others.  I  will  follow  that  system  of 
regimen  which,  according  to  my  ability  and  judg- 
ment, I  consider  for  the  benefit  of  my  patients, 
and  abstain  from  whatever  is  deleterious  and 
mischievous.  I  will  give  no  deadly  medicine  to 
anyone  if  asked,  nor  suggest  any  such  counsel; 
and  in  like  manner  I  will  not  give  to  a  woman  a 
pessary  to  produce  abortion.  With  purity  and 
with  holiness  I  will  pass  my  life  and  practise  my 
Art.  I  will  not  cut  persons  labouring  under  the 
stone,  but  will  leave  this  to  be  done  by  men  who 


36  GEEEK  AND   ROMAN   MEDICINE 

are  practitioners  of  this  work.  Into  whatever 
houses  I  enter,  I  will  go  into  them  for  the  benefit 
of  the  sick,  and  will  abstain  from  every  voluntary 
act  of  mischief  and  corruption,  and,  further,  from 
the  seduction  of  females  or  males,  of  freedmen  and 
slaves.  Whatever,  in  connection  with  my  pro- 
fessional practice,  or  not  in  connection  with  it,  I 
see  or  hear,  in  the  life  of  men,  which  ought  not  to 
be  spoken  of  abroad,  I  will  not  divulge  as  reckon- 
ing that  all  such  should  be  kept  secret.  While  I 
continue  to  keep  this  Oath  inviolate,  may  it  be 
granted  to  me  to  enjoy  life  and  the  practice  of  the 
Art,  respected  by  all  men,  in  all  times !  But 
should  I  trespass  or  violate  this  oath,  may  the 
reverse  be  my  lot !  " 

It  would  be  a  great  task  to  attempt  anything 
like  a  full  review  of  the  writings  of  this  great 
doctor  of  antiquity,  but  enough  has  been  written 
to  reveal  the  great  powers  of  his  mind,  and  to 
show  that  he  was  far  in  advance  of  his  predecessors, 
and  a  model  for  his  successors.  In  the  island  of 
Cos,  made  illustrious  by  the  name  of  Hippocrates, 
it  is  strange  to  find  that  he  has  no  fame  now 
other  than  that  of  being  regarded  in  the  confused 
minds  of  the  people  as  one  of  the  numerous  saints 
of  the  Greek  Church.^ 

"  When,"  says  Littre,  "  one  searches  into  the 
history   of  medicine   and   the    commencement    of 

^  Archiv  fiir  Geschichte  der  Medizin,  May,  1912. 


HIPPOCEATES  37 

science,  the  first  body  of  doctrine  that  one  meets 
with  is  the  collection  of  writings  known  under  the 
name  of  the  works  of  Hippocrates.  The  science 
mounts  up  directly  to  that  origin,  and  there 
stops.  Not  that  it  had  not  been  cultivated 
earlier,  and  had  not  given  rise  to  even  numerous 
productions ;  but  everything  that  had  been  made 
before  the  physician  of  Cos  has  perished.  We 
have  only  remaining  of  them  scattered  and  un- 
connected fragments.  The  works  of  Hippocrates 
have  alone  escaped  destruction ;  and  by  a  singular 
circumstance  there  exists  a  great  gap  after  them 
as  well  as  before  them.  The  medical  works  from 
Hippocrates  to  the  establishment  of  the  School  of 
Alexandria,  and  those  of  that  school  itself,  are 
completely  lost,  except  some  quotations  and 
passages  preserved  in  the  later  writers;  so  that 
the  writings  of  Hippocrates  remain  alone  amongst 
the  ruins  of  ancient  medical  literature."  Sydenham 
said  of  Hippocrates :  "  He  it  is  whom  we  can  never 
duly  praise,"  and  refers  to  him  as  "  that  divine  old 
man,"  and  "  the  Komulus  of  medicine,  whose 
heaven  was  the  empyrean  of  his  art." 

Hippocrates  died  in  Thessaly,  but  at  what  age 
is  uncertain,  for  different  authors  have  credited  him 
with  a  lifetime  of  from  eighty-five  to  a  hundred 
and  nine  years.  By  virtue  of  his  fame,  death  for 
him  was  not  the  Great  Leveller. 

Hippocrates    had    two     sons,    Thessalus     and 
Draco;    the  former  was  physician   to   Archelaus, 


38  GEEEK  AND   EOMAN  MEDICINE 

King  of  Macedonia,  the  latter  physician  to  the 
wife  of  Alexander  the  Great.  They  were  the 
founders  of  the  School  of  Dogmatism  which  was 
based  mainly  on  the  teaching  and  aphorisms  of 
Hippocrates.  The  Dogmatic  Sect  emphasized  the 
importance  of  investigating  not  the  obvious  but 
the  underlying  and  hidden  causes  of  disease  and 
held  undisputed  sway  until  the  foundation  of  the 
Empirical  Sect  at  Alexandria. 


39 


CHAPTEE  IV. 

PLATO,  AEISTOTLE,  THE  SCHOOL  OF  ALEXANDEIA 
AND    EMPIRICISM. 

Plato — Aristotle — Alexandrian  School — Its  Origin — Its  Influ- 
ence— Lithotomy — Herophilus — Erasistratus — Cleombro- 
tus  —  Chry sippos — Anatomy — Empiricism  —  Serapion  of 
Alexandria. 

Two  very  eminent  philosophers,  Plato  and 
Aristotle,  were  influenced  by  the  teaching  of 
Hippocrates. 

Flato  (B.C.  427-347)  was  a  profound  moralist,  and 
though  possessed  of  one  of  the  keenest  intellects 
of  all  time,  did  little  to  advance  medical  science. 
He  did  not  practise  medicine,  but  studied  it  as  a 
branch  of  philosophy,  and  instead  of  observing  and 
investigating,  attempted  to  solve  the  problems  of 
health  and  disease  by  intuition  and  speculation. 
His  conceptions  were  inaccurate  and  fantastic. 

He  elaborated  the  humoral  pathology  of 
Hippocrates.  The  world,  he  thought,  was  composed 
of  four  elements  :  fire  consisting  of  pyramidal, 
earth  of  cubical,  air  of  octagonal,  and  water  of 
twenty-sided  atoms.  The  marrow  consists  of 
triangles,  and  the  brain  is  the  perfection  of  marrow. 
The  soul  dominates  the  marrow  and  the  separation 
of  the  two  causes  death.     The  purpose  of  the  bones 


40  GREEK  AND   ROMAN   MEDICINE 

and  muscles  is  to  protect  the  marrow  against 
changes  of  temperature.  Plato  divided  the  "  soul " 
into  three  parts :  Eeason,  enthroned  in  the  brain ; 
courage  in  the  heart ;  and  desire  in  the  liver.  The 
uterus,  he  believed,  excites  inordinate  desires. 
Inflammations  are  due  to  disorders  of  the  bile,  and 
fevers  to  the  influence  of  the  elements.  His 
theories  in  regard  to  the  special  senses  are  very 
fantastic,  for  instance,  smell  is  evanescent  because 
it  is  not  founded  on  any  external  image;  taste 
results  from  small  vessels  carrying  taste  atoms  to 
the  heart  and  soul. 

Aristotle,  born  B.C.  334,  was  the  son  of  Nicho- 
machus,  physician  to  the  King  of  Macedonia,  and 
of  the  race  of  the  Asclepiads.  His  inherited  taste 
was  for  the  study  of  Nature ;  he  attained  the 
great  honour  of  being  the  founder  of  the 
sciences  of  Comparative  Anatomy  and  Natural 
History,  and  contributed  largely  to  the  medical 
knowledge  of  his  time.  Aristotle  went  to  Athens 
and  became  a  follower  of  Plato,  and  the  close 
companionship  of  these  two  great  men  lasted  for 
twenty  years.  At  the  age  of  42,  Aristotle 
was  appointed  by  Philip  of  Macedon  tutor  to 
Alexander  the  Great,  who  was  then  aged  15, 
and  the  interest  of  that  mighty  prince  was 
soon  aroused  in  the  study  of  Natural  History. 
Aristotle  and  Alexander  the  Great,  teacher  and 
pupil,  founded  the  flrst  great  Natural  History 
Museum,  to  which  specimens  were  sent  from  places 


THE    SCHOOL   OF   ALEXANDRIA  AND  EMPIEICISM       41 

scattered  over  the  then  known  world.  Aristotle, 
besides  his  philosophical  books,  wrote :  "  Re- 
searches about  Animals,"  "On  Sleep  and  Waking," 
"  On  Longevity  and  Shortlivedness,"  "  On  Parts  of 
Animals,"  "  On  Respiration,"  "  On  Locomotion  of 
Animals,"  and  "  On  Generation  of  Animals."  He 
was  greatly  helped  in  the  supply  of  material  for 
dissection  in  his  study  of  comparative  anatomy 
by  his  pupil,  Alexander  the  Great.  Aristotle 
pointed  out  the  differences  in  the  anatomy  of 
men  and  monkeys ;  he  described  the  anatomy  of 
the  elephant  and  of  birds,  and  also  the  changes 
in  development  seen  during  the  incubation  of  eggs. 
He  investigated,  also,  the  anatomy  of  fishes  and 
reptiles.  The  stomachs  of  ruminant  animals  ex- 
cited his  interest,  and  he  described  their  structure. 
The  heart,  according  to  Aristotle,  was  the  seat  of 
the  soul,  and  the  birthplace  of  the  passions,  for  it 
held  the  natural  fire,  and  in  it  centred  movement, 
sensation  and  nourishment.  The  diaphragm,  he 
believed,  separated  the  heart,  the  seat  of  the  soul, 
from  the  contaminating  influences  of  the  intestines. 
He  did  not  advance  beyond  the  conception  that 
nerves  were  akin  to  ligaments  and  tendons,  and  he 
believed  that  the  nerves  originated  in  the  heart,  as 
did  also  the  blood-vessels.  He  named  the  aorta 
and  ventricles.  He  investigated  the  action  of  the 
muscles,  and  held  that  superfoetation  was  possible. 
When  Aristotle  retired  to  Chalcis,  he  chose 
Tyrtamus,    to    whom    he     gave     the    name     of 


42  GEEEK  AND   ROMAN   MEDICINE 

TJieophrastuSj  as  his  successor  at  the  Lyceum. 
Theophrastus  was  the  originator  of  the  science 
of  Botany,  and  wrote  the  "  History  of  Plants." 
He  also  wrote  about  stones,  and  on  physical,  moral 
and  medical  subjects. 

The  Alexandeian  School. 

"  In  the  year  331  B.C.,"  wrote  Kingsley,  "  one  of 
the  greatest  intellects  whose  influence  the  world 
has  ever  felt,  saw,  with  his  eagle  glance,  the 
unrivalled  advantages  of  the  spot  which  is  now 
Alexandria,  and  conceived  the  mighty  project  of 
making  it  the  point  of  union  of  two,  or  rather  of 
three  worlds.  In  a  new  city  named  after  himself, 
Europe,  Asia  and  Africa  were  to  meet  and  hold 
communion."  The  School  of  Alexandria  became, 
after  the  decay  of  Greek  culture,  the  centre  of 
learning  for  the  world,  and  when  the  Empire  of 
Alexander  the  Great  was  subdivided,  the  Egyptian 
share  fell  to  the  first  Ptolemy,  who,  under  the 
direction  of  Aristotle,  founded  the  Alexandrian 
Library,  containing  at  first  fifty  thousand,  and 
finally  seven  hundred  thousand  volumes.  Every 
student  who  came  to  the  University  of  Alexandria, 
and  possessed  a  book  of  which  there  was  not  a  copy 
in  the  Alexandrian  Library,  was  compelled  to 
present  the  book  to  the  library.  The  first  Ptolemy 
also  fostered  the  study  of  medicine  and  of  dissec- 
tion.    Eumenes  likewise   established   a  library  at 


THE    SCHOOL   OF  ALEXANDRIA  AND   EMPIRICISM        43 

Pergamos.  It  is  instructive  to  follow  the  history 
of  the  great  Library  of  Alexandria.  The  greater 
part  of  the  library,  which  contained  the  collected 
literature  of  Greece,  Eome,  India  and  Egypt,  was 
housed  in  the  famous  museum  in  the  part  of 
Alexandria  called  the  Brucheion.  This  part  was 
destroyed  by  fire  during  the  siege  of  Alexandria  by 
Julius  Caesar.  Mark  Antony,  then,  at  the  urgent 
desire  of  Cleopatra,  transferred  to  Alexandria  the 
books  and  manuscripts  from  Pergamos.  The  other 
part  of  the  library  was  kept  at  Alexandria  in  the 
Serapeum,  the  temple  of  Jupiter  Serapis,  and  there 
it  remained  till  the  time  of  Theodosius  the  Great, 
until  in  391  a.d.  both  temple  and  library  were 
almost  completely  destroyed  by  a  fanatical  mob  of 
Christians  led  by  the  Archbishop  Theophilus.  When 
Alexandria  was  taken  by  the  Arabs  in  641,  under 
the  Calif  Omar,  the  destruction  was  completed. 

Ptolemy  gathered  to  the  museum  at  Alexandria  a 
number  of  very  learned  men,  who  lived  within  its 
walls  and  were  provided  with  salaries,  the  whole 
system  closely  resembling  a  university.  Grammar, 
prosody,  mythology,  astronomy  and  philosophy 
were  studied,  and  great  attention  was  given  to 
the  study  of  medicine.  Euclid  was  the  teacher 
of  Mathematics,  and  Hipparchus  of  Alexandria 
was  the  father  of  Astronomy.  The  teaching  of 
medicine  and  of  astronomy  was  for  long  based  upon 
observation  of  ascertained  facts.  The  Alexandrian 
School  endured  for  close  upon  a  thousand  years. 


44  GEEEK  AND   ROMAN   MEDICINE 

and  its  history  may  be  divided  into  two  periods, 
namely,  from  323  to  30  B.C.,  during  the  period  of  the 
Ptolemies,  and  from  30  B.C.  to  640  a.d.  The  second 
period  was  distinguished  for  the  study  of  speculative 
philosophy,  and  of  the  religious  philosophy  of  the 
Gnostics,  and  was  not  a  scientific  period. 

Julius  Caesar  was  not  the  only  Eoman  Emperor 
who  brought  trouble  upon  the  Alexandrian  School, 
for  the  brutal  Caracalla  took  away  the  salaries  and 
privileges  from  the  savants,  and  prohibited  scientific 
exhibitions  and  discussions.  In  recent  excavations 
in  the  Baths  of  Caracalla  in  Eome,  the  ruins  of  a 
library  have  been  discovered,  and  it  is  believed  by 
some  archaeologists  that  Caracalla  supplied  this 
library  with  books  and  parchments  from  Alexandria. 

The  Asclepiadse  of  Cos  and  Cnidos  had  dis- 
coursed upon  the  phenomena  of  disease,  without 
attempting  to  demonstrate  its  structural  relations ; 
like  the  sculptors  of  their  own  age,  they  studied  the 
changing  expression  of  vital  action  almost  wholly 
from  an  external  point  of  view.  They  meddled 
not  with  the  dead,  for,  by  their  own  laws,  no  one 
was  allowed  to  die  within  the  temple.  But  the 
early  Alexandrians  were  subject  to  no  such  restric- 
tions ;  and  turning  to  good  account  the  discoveries 
of  Aristotle  in  natural  history  and  comparative 
anatomy,  they  undertook  for  the  first  time  to 
describe  the  organization  of  the  human  frame 
from  actual  dissections.^ 

"  The  Medical  Profession  in  Ancient  Times."  Watson,  p.  90. 


THE   SCHOOL   OF  ALEXANDRIA  AND   EMPIRICISM        46 

Thus  there  was  inaugurated  at  Alexandria  the 
Anatomic  Period  of  Medicine,  which  lasted  till 
Egypt  came  under  the  sway  of  the  Eomans. 
Medical  practice  became  so  flourishing  at  Alexandria 
that  three  great  specialities  were  established, 
namely,  Surgery,  Pharmacy,  and  Dietetics,  and  a 
great  variety  of  operations  were  performed. 
Lithotomy  was  much  practised  by  specialists. 
A  foul  murder  was  perpetrated  by  lithotomists 
at  the  instigation  of  Diodotus,  the  guardian  of 
Antiochus,  son  of  Alexander,  King  of  Syria 
(150  B.C.),  young  Antiochus,  at  the  age  of  10, 
being  done  to  death  under  the  pretence  that  he 
had  a  stone  in  his  bladder. 

About  150  B.C.  a  sect  called  the  Essenes  was 
established  for  the  study  of  curative  and  poisonous 
substances.  The  members  were  not  all  physicians, 
by  any  means,  for  one  of  the  chief  was  King 
Mithridates,  who  invented  the  remedy  known  as 
mithridaticum.  This  celebrated  nostrum  of 
antiquity  is  said  to  have  been  a  confection  of 
twenty  leaves  of  rue,  a  few  grains  of  salt,  two 
walnuts,  and  two  figs,  intended  to  be  taken  every 
morning  and  followed  by  a  draught  of  wine. 

Two  famous  physicians  and  anatomists, 
Herophilus  (335-280  b.c.)  and  Erasistratus  (280 
B.C.)  took  part  in  the  medical  teaching  at  Alexandria 
in  the  early  days  of  that  seat  of  learning.  It  is 
recorded  that  they  did  not  confine  their  investiga- 
tions to  the  dissection  of  the  dead,  but  also  vivisected 


46  GREEK   AXD   EOLIAN   MEDICINE 

criminals.  Cleombrotiis,  another  physician  at  this 
school,  was  sent  for  to  attend  King  Antiochus, 
and  was  rewarded  with  a  hundred  talents,  equal 
to  about  i;15,000  sterling. 

There  were  several  physicians  of  the  name  of 
Chrysippos  connected  with  the  Alexandrian  SchooL 
One  was  physician  to  Ptolemy  Soter,  the  King 
of  Egypt,  and  tutor  to  Erasistratus.  This 
CMysippos  introduced  the  practice  of  emptying  a 
limb  of  blood  before  amputation,  according  to  the 
recent  method  of  Esmarch,  and  is  said  to  have 
employed  vapour  baths  in  the  treatment  of  dropsy. 
In  Alexandria,  anatomy  was  properly  studied.^ 
HeropJiihis  made  many  anatomical  discoveries^ 
and  some  of  the  names  he  gave  to  parts  of  the 
body  are  now  in  use,  for  instance,  torcular 
Herophili,  calamus  scriptorius,  and  duodenum. 
He  described  the  connection  between  the  nerves 
and  the  brain,  and  the  various  parts  of  the  brain, 
and  recognized  the  essential  difference  between 
motor  and  sensory  nerves,  although  he  thought 
the  former  arose  in  the  membranes  and  the  latter 
in  the  substance  of  the  brain.  He  believed  that 
the  fourth  ventricle  was  the  seat  of  the  soul.  He 
attributed  to  the  heart  the  pulsations  of  the 
arteries,  but  thought  that  the  pulmonary  veins 
conveyed  air  from  the  lungs  to   the   left  side   of 

^  Arctinus  :  "  Ethiopis,"  Translated  in  Puschmann's  "  Hist. 
Med.  Education." 


THE    SCHOOL   OF   ALEXANDEIA  AND   EMPIRICISM        47 

the  heart,  and  he  observed  the  lacteals  without 
determining  their  function.  Herophilus  operated 
upon  the  Hver  and  spleen,  and  looked  upon  the 
latter  as  of  little  consequence  in  the  animal 
economy.  He  had  a  good  knowledge  of  obstetric 
operations.  His  ideas  in  relation  to  pathology 
did  not  proceed  much  further  than  the  belief 
that  disease  was  due  to  corruption  of  the  humors. 
He  was  more  scientific  and  accurate  when  he 
taught  that  paralysis  results  from  a  defect  in  the 
nerves. 

Erasistratus  studied  under  Chrysippos  (or 
Chrysippus),  and  under  Metrodorus,  the  son-in- 
law  of  Aristotle.  Herophilus  had  been  a  student 
at  Cos,  Erasistratus  at  Cnidos,  so  that  the 
teaching  of  the  two  great  Greek  medical  schools 
was  introduced  into  Alexandria.  Xenophon,  of 
Cos,  one  of  the  followers  of  Erasistratus,  first 
resorted  to  the  ligation  of  vessels  for  the  arrest 
of  hsemorrhage,  although  for  many  years  in  later 
times  this  important  practice  was  lost  through  the 
neglect  of  the  study  of  the  history  of  medicine. 
Erasistratus  and  Herophilus,  it  is  sad  to  relate, 
considered  that  vivisection  of  human  beings,  as 
well  as  dissection  of  the  dead,  was  a  necessary  part 
of  medical  education,  and  believed  that  the 
sufferings  of  a  few  criminals  did  not  weigh  against 
the  benefit  likely  to  accrue  to  innocent  people, 
who  could  be  relieved  or  cured  of  disease  and 
suffering  as  the  result  of  the  knowledge  gained  by 


48  GREEK  AND   EOMAN   MEDICINE 

dissection  of  the  living.  This  cruel  and  nefarious 
practice  was  followed  ''  so  that  the  investigators 
could  study  the  particular  organs  during  life  in 
regard  to  position,  colour,  form,  size,  disposition 
hardness,  softness,  smoothness,  and  superficial 
extent,  their  projection  and  curvatures." 

The  followers  of  these  teachers,  unfortunately, 
became  very  speculative  and  fond  of  discussions 
of  a  fruitless  kind,  and,  according  to  Pliny,  it  was 
easier  "  to  sit  and  listen  quietly  in  the  schools  than 
to  be  up  and  wandering  over  the  deserts,  and  to 
seek  out  new  plants  every  day,"^  and  so,  in  the 
third  centmy  before  Christ,  the  school  of 
Empiricism  was  established,  the  system  of  which 
resembled  the  older  Scepticism.  It  rested  upon  the 
"  Empiric  tripod,"  namely,  accident,  history  and 
analogy.  This  meant  that  discoveries  were  made 
by  accident,  knowledge  was  accumulated  by  the 
recollection  of  previous  cases,  and  treatment 
adopted  which  had  been  found  suitable  in  similar 
circumstances.  Pliilinus  of  Cos,  a  pupil  of 
Herophilus,  declared  that  all  the  anatomy  he  had 
learned  from  his  master  did  not  help  him  in  the 
least  to  cure  diseases.  Philinus,  according  to  Galen, 
founded  the  Empirici,  the  first  schismatic  sect  in 
medicine.  Celsus^  wrote  of  this  sect  that  they 
admit    that    evident    causes    are    necessary,    but 

^  Pliny,  "Hist.  Nat.,"  xxvi,  6. 

=  "  De  Med.,"  Prgefat.    (Translation.) 


THE   SCHOOL   OF   ALEXANDEIA  AND   EMPIEICISM         49 

deprecate  inquiry  into  them  because  Nature  is 
incomprehensible.  This  is  proved  because  the 
philosophers  and  physicians  who  have  spent  so 
much  labour  in  trying  to  search  out  these  occult 
causes  cannot  agree  amongst  themselves.  If 
reasoning  could  make  physicians,  the  philosophers 
should  be  most  successful  practitioners,  as  they 
have  such  abundance  of  words.  If  the  causes  of 
diseases  were  the  same  in  all  places,  the  same 
remedies  ought  to  be  used  everywhere.  Eelief 
from  sickness  is  to  be  sought  from  things  certain 
and  tried,  that  is  from  experience,  which  guides 
us  in  all  other  arts.  Husbandmen  and  pilots 
do  not  reason  about  their  business,  but  they 
practise  it.  Disquisitions  can  have  no  connection 
with  medicine,  because  physicians  whose  opinions 
have  been  directly  opposed  to  one  another  have 
equally  restored  their  patients  to  health  ;  they  did 
not  derive  their  methods  of  cure  from  studying  the 
occult  causes  about  which  they  disputed,  but  from 
the  experience  they  had  of  the  remedies  which 
they  employed  upon  their  patients.  Medicine  was 
not  first  discovered  in  consequence  of  reasoning, 
but  the  theory  was  sought  for  after  the  discovery 
of  medicine.  Does  reason,  they  ask,  prescribe  the 
same  as  experience,  or  something  different  ?  If  the 
same,  it  must  be  needless ;  if  different,  it  must  be 
mischievous. 

In  the  third  and  second  centuries  before  Christ, 
many  physicians  wrote  commentaries  on  diseases 

4: 


50  GREEK  AND   EOMAN   MEDICINE 

and  attacked  the  teaching  of  Hippocrates.  Among 
these,  Serainon  of  Alexandria,  an  Empiric  who 
lived  in  the  third  century  before  Christ,  is  note- 
worthy for  having  first  used  sulphur  in  the  treat- 
ment of  skin  diseases,  and  Heraclides  wrote  on 
strangulated  hernia.  Serapion  added  somewhat  to 
the  system  of  Philinus,  and  was  responsible  for 
introducing  the  principle  of  analogy  into  the  system 
of  Empiricism.  The  foundation  of  Empiricism 
marked  the  decline  of  the  medical  school  of 
Alexandria.  We  are  indebted  to  Celsus  for  a  full 
description  of  the  teaching  of  this  sect,  and,  at 
the  same  time,  for  an  exposure  of  its  fallacies. 
Serapion  was  a  convert  from  the  school  of  Cos, 
which  was  the  stronghold  of  medical  dogmatism, 
and,  like  nearly  all  apostates,  he  was  consumed  with 
animosity  and  bitterness  towards  those  with  whom 
he  had  formerly  been  in  agreement.  Cnidos  was 
the  stronghold  of  the  Empirics. 


51 


CHAPTER  V. 

EOMAN  MEDICINE  AT  THE  END  OF  THE  EEPUBLIO 
AND  THE  BEGINNING  OF  THE  EMPIEE. 

Asclepiades  of  Prusa — Themison  of  Laodicea — Methodism — 
Wounds  of  Julius  Caesar — Systems  of  Philosophy — State 
of  the  country — Eoman  quacks — Slaves  and  Freedmen — 
Lucius  Horatillavus. 

Asclepiades  of  Prusa,  in  Bithynia,  was  a  famous 
physician  in  Eome  early  in  the  first  century  before 
Christ.  He  studied  both  rhetoric  and  medicine  at 
Alexandria  and  at  Athens.  He  began  as  a  teacher 
of  rhetoric  in  Rome,  but,  although  he  was  the  friend 
of  Cicero,  he  was  not  very  successful,  and  abandoned 
this  study  for  the  practice  of  medicine.  He  had  a 
great  deal  of  ability  and  shrewdness,  but  no  know- 
ledge of  anatomy  or  physiology,  and  he  condemned 
all  who  thought  that  these  subjects  of  study  were 
the  foundation  of  the  healing  art.  He  specially 
inveighed  against  Hippocrates,  and  with  some 
reason,  for  the  disciples  of  Hippocrates  had  elevated 
the  teaching  of  their  master  almost  into  a  religion, 
and  were  bound  far  too  closely  to  his  authority,  to 
the  exclusion  of  original  thought  and  progress. 

Asclepiades  had  many  pupils,  and  his  teaching 
led  to  the  foundation  of  the  Medical  School  of 
the  Methodists.  His  most  important  maxim  was 
that  a  cure  should  be  effected  "  tuto^  celeriter,  ac 


52  GREEK  AND   EOMAN   MEDICINE 

jucunde^'"  and  he  believed  that  what  the  physician 
could  do  was  of  primary  importance,  and  vis 
medicatrix  naturce  only  secondary.  He  was  thus 
directly  opposed  to  the  teaching  of  Hippocrates. 
He  had  little  or  no  faith  in  drugs,  and  relied 
mainly  upon  diet,  exercises  and  massage,  and,  to 
some  extent,  upon  surgery.  His  practice  of  pre- 
scribing wine  in  liberal  doses  added  to  his  popularity. 
It  was  the  custom  to  take  wine  very  much  diluted 
with  water,  but  Asclepiades  ordered  wine  in  full 
strength  or  only  slightly  diluted.  He  practised 
bronchotomy  and  tracheotomy,  and  recommended 
in  suitable  cases  of  dropsy  scarification  of  the 
ankles,  and  advised  that,  in  tapping,  an  opening 
as  small  as  possible  should  be  made.  He  also 
observed  spontaneous  dislocation  of  the  hip.  He 
was  a  very  famous  man  in  the  Koman  Eepublic, 
and  was  well  acquainted  with  philosophy,  especi- 
ally the  philosophy  of  the  Epicureans.  Although 
he  was  almost  entirely  ignorant  of  anatomy, 
he  was  far  from  being  a  quack.  He  had 
great  powers  of  observation  and  natural  shrewd- 
ness, and  his  success  largely  contributed  to 
the  establishment  of  Greek  doctors  and  their 
methods  in  Eome.  There  is  grim  humour  in  his 
description  of  the  Hippocratic  treatise  on  thera- 
peutics, which  he  called  "  a  meditation  on  death." 
Pliny  relates  that  Asclepiades  wagered  that  he 
would  never  die  of  disease,  and  he  won  the  wager, 
for  he  lived  to  old  age  and  died  of  an  accident ! 


ROMAN  MEDICINE  AT  THE  END  OF  THE  REPUBLIC   53 

Themison,  of  Laodicea,  lived  in  the  first 
century  before  Christ,  and  was  a  pupil  of 
Asclepiades  of  Prusa,  the  founder  of  the  School 
of  Methodism.  His  views  on  atoms  and  pores 
led  him  to  adopt  a  very  simple  explanation  of 
health  and  disease,  for  he  considered  that  these 
pores  must  be  either  constricted  or  dilated,  and  the 
aim  of  the  physician  should  be  to  dilate  the  con- 
striction, and  vice  versa.  This  epitomized  system 
of  medicine  did  away  with  the  use  of  many  classes 
of  drugs,  and,  from  its  simplicity,  was  quickly 
learned.  A  jeering  opponent  of  the  system  of  the 
Methodici  said  that  it  could  be  taught  in  six 
months,  and  Galen,  in  later  years,  ridiculed  it, 
and  called  its  practitioners  "  the  asses  of  Thessaly." 

The  great  fault  of  Dogmatism  was  its  absolute 
reliance  on  the  wisdom  of  Hippocrates,  and 
Methodism  was  marred  by  its  insufficiency  and 
sophistry. 

In  spite  of  his  extravagant  theories,  Themison 
possessed  skill  in  practice.  He  was  the  first 
physician  to  describe  rheumatism,  and  he  also  is 
thought  to  have  been  the  pioneer  in  the  medicinal 
use  of  leeches.  A  book  on  elephantiasis  ascribed 
to  him  is  not  definitely  known  to  be  authentic. 
It  is  worthy  of  note  that  he  was  anxious  to  write 
on  hydrophobia,  but  a  case  he  had  seen  in  early 
youth  so  impressed  his  mind  with  horror  that  the 
mere  thought  of  the  disease  caused  him  to  suffer 
some  of  the  symptoms. 


54  GEEEK  AND   ROMAN   MEDICINE 

The  views  of  the  Methodists  were  less  extreme 
than  those  of  the  Dogmatists  and  Empirics.  Celsus 
wrote  of  the  Methodists :  "  They  assert  that  the 
knowledge  of  no  cause  whatever  bears  the  least 
relation  to  the  method  of  cure;  and  that  it  is 
suJG&cient  to  observe  some  general  symptoms  of 
distempers ;  and  that  there  are  three  kinds  of 
diseases,  one  bound,  another  loose,  and  the  third 
is  a  mixture  of  these."  ^ 

There  were  several  physicians  of  the  name  of 
Themison  at  different  times,  and  it  is  probably  the 
founder  of  the  Methodici  who  was  satirized  by 
Juvenal  thus: — 

"  How  many  patients  Themison  dispatched 
In  one  short  autumn."  ^ 

The  joke  which  is  based  on  attributing  a  cure  to 
Nature  alone,  and  death  solely  to  the  physician's 
want  of  skill,  is  one  of  the  most  time-honoured. 

Themison  lived  at  the  close  of  the  Eoman 
Eepublic,  and  it  will  now  be  necessary  to  consider 
the  state  of  the  healing  art  in  Eome  under  the  rule 
of  the  emperors. 

Julius  Caesar — one  of  the  first  triumvirate — 
invaded  and  conquered  Gaul  and  Britain,  and  after 
these  great  military  achievements,  found  that  he 
could  not  sheath  his  sword  until  he  had  met  in 
battle  his  rival  Pompey.  C^sar  defeated  Pompey 
at  Pharsalia,  in  Thessaly  (48   B.C.),  and  pursued 

1  "De  Medic,"  lib.  1.  ^  "  Safc.,"  x,  221. 


ROMAN   MEDICINE   AT   THE   END   OF  THE   REPUBLIC      55 

him  to  Egypt.  Pompey  was  murdered  in  Egypt, 
and  his  last  followers  finally  defeated  in  Spain,  and 
in  45  B.C.  Julius  Csesar  returned  to  Eome,  and 
was  declared  perpetual  imperator.  On  March  15, 
44  B.C.,  he  was  assassinated.  It  is  possible  that 
the  career  of  this  great  man  may  have  promoted 
the  surgery  of  the  battlefield,  but  his  reign  as 
Emperor  was  too  shorty  and  the  political  situation 
of  his  time  too  acute,  to  permit  of  much  progress 
in  the  arts  of  peace  generally,  and  in  the  medical 
art  particularly.  Julius  Csesar  bestowed  the  right 
of  Boman  citizenship  on  all  medical  practitioners 
in  the  city. 

Eeferring  to  the  death  of  Julius  Caesar,  Suetonius 
writes  that  among  so  many  wounds  there  was 
none  that  was  mortal,  in  the  opinion  of  the  surgeon 
Antistus,  except  the  second,  which  he  received  in 
the  breast. 

Octavianus  was  appointed  one  of  the  second 
triumvirate,  his  colleagues  being  Mark  Antony  and 
Lepidus.  Lepidus  was  first  forced  out  of  the 
triumvirate,  and  Octavianus  and  Mark  Antony 
then  came  into  conflict.  During  these  rivalries, 
a  great  civic  work  was  accomplished  by  Marcus 
Agrippa,  who  built  the  aqueduct  known  as  Aqua 
Julia.  A  landmark  in  history  is  the  battle  of 
Actium,  in  which  Octavianus  defeated  Mark 
Antony  and  his  ally  Cleopatra,  and  within  a  few 
years  Octavianus  was  proclaimed  Emperor  as 
Augustus  Caesar  (27  B.C.).     Under  his  rule  Eome 


56  GREEK  AND   ROMAN   MEDICINE 

greatly  prospered,  and  we  shall  now  consider  the 
state  of  medicine  and  of  sanitation  during  his 
illustrious  reign. 

In  the  Eoman  Empire  there  was  a  spirit  of 
toleration  abroad,  "  and  the  various  modes  of 
worship  which  prevailed  in  the  Eoman  world  were 
all  considered  by  the  people  as  equally  true  ;  by  the 
philosopher,  as  equally  false ;  and  by  the  magistrate, 
as  equally  useful.  And  thus  toleration  produced 
not  only  mutual  indulgence,  but  even  religious 
concord"  (Gibbon). 

The  systems  of  philosophy  in  vogue  were  those 
of  the  Stoics,  the  Platonists,  the  Academics,  and 
the  Epicureans,  and  of  these  only  the  Platonists 
had  any  belief  in  God,  who  was  to  them  an  idea 
rather  than  a  Supreme  Being.  The  great  aim  of 
both  the  wise  and  the  foolish  was  to  glorify  their 
nationality,  and  their  beliefs,  their  rites,  and  their 
superstitions,  were  all  for  the  glory  of  mighty 
Eome. 

Educated  Eomans  were  able  to  speak  and  write 
both  Latin  and  Greek,  and  the  latter  language  was 
the  vehicle  used  by  men  of  science  and  of  letters. 

The  population  of  the  city  of  Eome  at  the 
beginning  of  the  Augustan  age  was  not  less  than 
half  a  million  of  people,  and  probably  exceeded 
this  number.  There  was  no  middle  class,  a 
comparatively  small  number  of  gentry,  a  very 
numerous  ^lehs  or  populace,  and  many  slaves. 
The  Emperor  Augustus  boasted  that  after  the  war 


ROMAN   MEDICINE   AT   THE    END   OF   THE   EEPUBLIC      57 

with  Sextus  Pompeius  he  handed  over  30,000 
slaves,  who  had  been  serving  with  the  enemy, 
to  their  masters  to  be  punished.  The  slaves 
were  looked  upon  by  their  masters  as  chattels. 
The  plebs  had  the  spirit  of  paupers  and,  to  keep 
them  contented  and  pacific,  were  fed  and  shown 
brutalizing  spectacles  in  the  arenas.  Augustus 
wrote  that  he  gave  the  people  wild-beast  hunts 
in  the  circus  and  amphitheatres  twenty-six  times, 
in  which  about  3,500  animals  were  killed.  It  was 
his  custom  to  w^atch  the  Circensian  games  from  his 
palace  in  view  of  a  multitude  of  spectators. 

Throughout  the  country  generally  agriculture 
prospered,  and  the  supply  of  various  grasses  for 
feeding  cattle  in  the  winter  increased  the  multi- 
tude of  the  flocks  and  herds ;  great  attention  was 
given  also  to  mines  and  fisheries  and  all  forms  of 
industry.  Virgil  praised  his  beautiful  and  fertile 
country : — 

"  But  no,  not  Medeland  with  its  wealth  of  woods, 
Pair  Ganges,  Hermus  thick  with  golden  silt, 
Can  match  the  praise  of  Italy     .... 
Here  blooms  perpetual  spring,  and  summer  here 
In  months  that  are  not  summer's  ;  twice  teem  the  flocks  : 
Twice  does  the  tree  yield  service  of  her  fruit. 
Mark  too,  her  cities,  so  many  and  so  proud, 
Of  mighty  toil  the  achievement,  town  on  town 
Up  rugged  precipices  heaved  and  reared. 
And  rivers  gliding  under  ancient  walls."  ^ 

The  city  of  Eome  was  not  a  desirable  place  for 
medical  practice,  for  the  lower  classes  were  degraded 

^  Ehodes's  version. 


58  -  GREEK  AND   KOMAN   MEDICINE 

and  thriftless,  and  the  relatively  small  upper  classes 
were  tyrannical,  debauched,  superstitious,  selfish 
and  cruel.  The  younger  Pliny,  who  was  one  of 
the  best  type  of  Komans,  tried  to  investigate  the 
purity  of  the  lives  of  the  Christians,  and  did  not 
hesitate  to  put  to  torture  two  women,  deaconesses, 
who  belonged  to  the  new  religion,  but  he  "  could 
discover  only  an  obstinate  kind  of  superstition 
carried  to  great  excess."  His  conduct  and  his 
opinion  speak  eloquently  of  the  nature  of  a  Eoman 
gentleman  of  the  Empire.  As  for  the  state  of 
the  poor  under  Augustus,  200,000  persons  in 
Eome  received  outdoor  relief.  Although  the  rich 
had  every  luxury  that  desire  could  suggest  and 
wealth  afford,  the  great  need  of  the  common 
people  was  food.  The  city  had  to  rely  mainly  on 
imported  corn,  and  the  price  of  this  at  times 
became  prohibitive  owing  to  scarcity — sometimes 
the  result  of  piracy  and  the  dangers  of  the  sea, 
but  often  caused  by  artificial  means  owing  to  the 
merchants  "cornering"  the  supply — and  it  was 
necessary  for  the  State,  through  the  Emperor,  to 
intervene  to  make  regulations  and  to  distribute 
the  grain  free  or  below  its  market  value.  It  has 
been  computed  that  about  50,000  strangers  lived 
in  Eome,  many  of  whom  were  adventurers. 

The  imperial  city  was  the  happy  hunting-ground 
of  quacks,  who  gave  themselves  high-sounding 
names  and  wore  gorgeous  raiment.  They  went 
about  followed  by  a  retinue  of  pupils  and  grateful 


EOMAN   MEDICINE   AT   THE    END   OP   THE   EEPUBLIC      59 

patients.  In  some  cases  the  patients  were  com- 
pelled to  promise,  in  the  event  of  being  cured,  that 
they  would  serve  their  doctor  ever  afterwards.  The 
retinue  of  students,  no  doubt,  was  rather  disturb- 
ing to  a  nervous  patient,  and  Martial  wrote  : — 

"Faint  was  I  only,  Symmachus,  till  thou 

Backed  by  an  hundred  students,  throng'dst  my  bed ; 
An  hundred  icy  fingers  chilled  my  brow : 
I  had  no  fever;  now  I'm  nearly  dead."^ 

Besides  quack  doctors  there  were  drug  sellers 
(pharmacopola),  who  sold  their  medicines  in  booths 
or  hawked  them  in  the  city  and  the  country.  In 
the  time  of  the  Empire  the  medicines  of  the 
regular  practitioners  were  sold  with  a  label  which 
specified  the  name  of  the  drug  and  of  the  inventor, 
the  ingredients,  the  disease  it  was  to  be  used  for, 
and  the  method  of  taking  it.  Drug  sellers  dis- 
pensed cosmetics  as  well  as  medicines,  and  some 
of  the  itinerant  dealers  sold  poison.  The  regular 
physicians  bought  medicines  already  compounded 
by  the  druggists,  and  the  latter,  as  in  our  own 
day,  prescribed  as  well  as  the  physicians. 

Depilatories  were  much  in  vogue,  and  were 
usually  made  of  arsenic  and  unslaked  lime,  but 
also  from  the  roots  and  juices  of  plants.  They 
were  first  used  only  by  women,  but  in  later  times 
also  by  effeminate  men.  Tweezers  have  been  dis- 
covered which  were  adapted  for  pulling  out  hairs, 
and  most  of   the  depilatories  were  recommended 

^  Handerson's  translation. 


60  GEEEK  AND   EOMAN   MEDICINE 

to  be  applied  after  the  use  of  the  tweezers.  The 
duty  of  puhing  out  hairs  was  performed  by  slaves. 

Most  of  the  medical  practitioners  in  the  time  of 
Augustus  were  either  slaves  or  freedmen.  Posts 
of  responsibility  and  of  honour  were  sometimes 
assigned  to  freedmen,  as  is  shown  by  the  appoint- 
ment by  Nero  of  Helius,  a  freedman,  to  the 
administration  of  Eome  in  the  absence  of  his 
imperial  master.  Cicero  wrote  letters  to  his  freed- 
man Tiro  in  terms  of  friendship  and  affection. 
The  master  of  a  great  household  selected  a  slave 
for  his  ability  and  aptitude,  and  had  him  trained 
to  be  the  medical  adviser  of  the  household;  and 
the  skill  shown  by  the  doctor  sometimes  gained 
for  him  his  freedom. 

There  were  400  slaves  in  one  great  household 
of  Borne,  and  they  were  all  executed  for  not  having 
prevented  the  murder  of  their  master.^  It  is 
recorded  that  physicians  were  sometimes  com- 
pelled to  do  the  disgusting  work  of  mutilating 
slaves.^  The  price  of  a  slave  physician  was  fixed 
at  sixty  solidi.^  The  gTeat  majority  of  physicians 
in  Rome  were  freedmen  who  had  booths  in  which 
they  prescribed  and  compounded,  and  they  were 
aided  by  freedmen  and  slaves  who  were  both 
assistants  and  pupils.  The  medical  profession,  as 
has  been  shown,  never  attained  the  same  dignity 
as  in  Greece.     It  should  be  understood  that  there 

1  "  Tacit.  Annal.,"  xiv,  43. 

2  "  Paulus  ^gin.,"  vol.  ii,  p.  379.  ^  "  Just.  Cod.,"  vii. 


EOMAN  MEDICINE  AT  THE  END  OF  THE  REPUBLIC   61 

was  a  class  of  practising  physicians  in  Eome  quite 
distinct  from  the  slave  doctors.  The  following 
account  of  Lucius  Horatillavus,  a  Eoman  quack 
of  the  time  of  Augustus,  is  taken  from  the  British 
Medical  Journal  of  June  10,  1911,  and  originated 
in  an  article  in  the  Societe  Nouvelle,  written  by 
M.  Fernand  Mazade : — 

"  He  was  a  handsome  man,  and  came  from 
Naples  to  Eome,  his  sole  outfit  being  a  toga 
made  of  a  piece  of  cloth  adorned  with  obscene 
pictures  and  a  small  Asiatic  mitre.  Like  many 
of  his  kind  at  that  day,  he  sold  poisons  and  in- 
vented five  or  six  new  remedies  which  were  more 
or  less  haphazard  mixtures  of  wine  and  poisonous 
substances.  He  had  the  good  luck  to  cure  his 
first  patient,  Titus  Cnoeus  Leno,  who,  being  a 
poet,  straightway  constituted  himself  the  vates 
sacer  of  his  physician,  and  induced  some  of  his 
fashionable  mistresses  to  place  themselves  under 
his  hands.  So  profitable  was  Horatillavus's 
practice  that  he  is  said  to  have  saved  150,000 
sesterces  in  a  few  months.  But  for  a  moment  his 
good  fortune  seemed  to  abandon  him.  A  Eoman 
lady,  Sulpicia  Pallas,  died  suddenly  under  his 
ministrations.  This  may  have  been  due  to  his 
ignorance  or  carelessness ;  but  he  was  accused  of 
having  poisoned  his  patient.  This  event  might 
have  been  expected  to  bring  his  career  to  an  end ; 
but  it  was  not  long  before  he  recovered  the  confi- 
dence of  the  people  whom  he  deluded  with  his 
mystical  language  and  promises  of  cure.     He  had 


62  GREEK  AND  ROMAN   MEDICINE 

three  methods  of  treatment,  all  consisting  of 
baths — hot,  tepid,  or  cold — preceded  or  followed 
by  the  taking  of  wonder-working  medicines. 
Horatillavus  treated  every  kind  of  disease,  internal 
and  external ;  he  even  practised  midwifery,  which 
was  then  in  the  hands  of  women.  Ten  years  after 
he  settled  in  Eome  he  had  accumulated  a  fortune 
of  some  6,000,000  sesterces.  He  had  a  villa  at 
Tusculum,  whither  he  went  three  times  a  month ; 
there  he  led  a  luxurious  life  in  the  most  beautiful 
surroundings,  and  there  his  evil  fate  overtook 
him.  His  orchard  was  his  especial  pride.  One 
day  he  found  that  birds  had  played  havoc  with 
his  figs,  the  like  of  which  were  not  to  be  found  in 
Italy.  Determined  to  prevent  similar  depredations 
in  future,  he  poisoned  the  fig  trees.  Continuing 
his  walk,  he  plucked  fruits  of  various  kinds  here 
and  there.  While  eating  the  fruit  he  had  culled 
and  drinking  choice  wine,  he  put  into  his  mouth 
a  poisoned  fig,  which  he  had  inadvertently 
gathered,  and  quickly  died  in  convulsions.  Before 
passing  away,  however,  he  is  said  to  have  com- 
posed his  own  epitaph.  This  M.  Mazade  believes 
he  has  found.  It  reads :  "  The  manes  of  Sulpicia 
Pallas  have  avenged  her.  Here  lies  Lucius  Hora- 
tillavus, physician,  who  poisoned  himself."  If  the 
epitaph  is  genuine,  it  is  a  confession  of  guilt. 
The  death  of  the  quack  by  his  own  poison  is  a 
curious  Nemesis.  The  manner  of  his  death  proves 
that  it  was  accidental,  as  few  quacks  are  bold 
enough  to  take  their  own  medicines." 


63 


CHAPTEE  VI. 

IN  THE  EEIGN  OF  THE  C^SAES— TO  THE 
DEATH  OF  NEEO. 

Augustus — His  illnesses — Antonius  Musa — Maecenas — Tiberius 
—  Caligula  —  Claudius  —  Nero  —  Seneca  —  Astrology  — 
Archiater — Women  poisoners — Oculists  in  Eome. 

Long  before  the  settlement  of  the  constitu- 
tional status  of  Augustus  in  27  B.C.,  he  had  under- 
taken many  reforms.  In  34  B.C.,  Agrippa,  under 
the  influence  of  Augustus,  had  improved  the  water 
supply  of  Eome  by  restoring  the  Aqua  Marcia,  and 
Augustus  had  repaired  and  enlarged  the  cloacae, 
and  repaired  the  principal  streets.  Eoad  commis- 
sions were  appointed  27  B.C..  The  Aqua  Virgo 
was  built  19  B.C.  Many  of  the  collegia,  or  guilds, 
founded  for  the  promotion  of  the  interests  of  pro- 
fessions and  trades  had  been  misused  for  political 
purposes,  and  Augustus  deprived  many  of  them 
of  their  charters.  Cicrcs,  or  commissions,  were 
appointed  to  superintend  public  works,  streets  and 
the  water-supply ;  and  the  Tiber  was  dredged, 
cleansed  and  widened,  and  its  liability  to  overflow 
reduced.  No  new  building  could  be  built  more 
than  70  ft.  high.     Augustus  also   established  fire 


64  GREEK  AND   EOMAN   MEDICINE 

brigades.     It  has  been  said  that  he  found  the  city 
built  of  brick  and  left  it  built  of  marble. 

He  revived  many  old  religious  customs,  such  as 
the  Augury  of  Public  Health,  and  identified  him- 
self closely  with  the  rites  and  customs  of  the 
people.  He  inculcated  that  sense  of  duty  which 
the  Eomans  called  pietas,  and  attempted  to 
improve  the  morals  of  the  citizens  by  the  enact- 
ment of  sumptuary  laws;  the  philosophers  hoped 
to  do  good  in  the  same  direction  by  appealing  to 
the  intellect  and  reason,  a  method  that  was  equally 
ineffectual.  Marriages  and  an  increased  birth-rate 
were  encouraged,  and  parents  were  honoured  and 
given  special  privileges.  The  wisdom  and  prudence 
of  Augustus  were  strangely  accompanied  by 
credulity  and  superstition.  He  was  a  profound 
believer  in  omens,  and  attached  great  importance 
to  astrology.  His  horoscope  showed  that  he  was 
born  under  the  sign  of  Capricorn. 

He  suffered  from  various  illnesses,  although  in 
his  younger  days  he  looked  handsome  and  athletic. 
He  carefully  nursed  his  health  against  his  many 
infirmities,  avoiding  chiefly  the  free  use  of  the 
bath;  but  he  was  often  rubbed  with  oil,  and 
sweated  in  a  stove,  after  which  he  was  bathed  in 
tepid  water,  warmed  either  by  a  fire,  or  by  being 
exposed  to  the  heat  of  the  sun.  When,  on 
account  of  his  nerves,  he  was  obliged  to  have 
recourse  to  sea- water,  or  the  waters  of  Albula,  he 
was   contented  with   sitting   over  a  wooden   tub, 


IN  THE   BEIGN   OF   THE   C^SAES  65 

(which  he  called  by  a  Spanish  name,  Dureta)^  and 
plunging  his  hands  and  feet  in  the  water  by  turns/ 
His  physician  was  Antonius  Musa,  to  whom  was 
erected,  by  public  subscription,  a  statue  near  that 
of  ^sculapius.  During  an  attack  of  congestion  of 
the  liver  when  heat  failed  to  give  relief,  Antonius 
Musa  advised  cold  applications  for  the  Emperor, 
which  had  the  desired  effect.  Suetonius,  the 
historian,  wrote  that  this  was  "  a  desperate  and 
doubtful  method  of  cure."  A  more  desperate  and 
doubtful  method  of  cure,  however,  was  carried  out 
by  the  same  physician.  He  successfully  banished 
an  attack  of  sciatica  that  greatly  troubled  Augustus 
by  the  expedient  of  beating  the  affected  part  with 
a  stick.  Antonius  Musa  received  honours  from 
Augustus,  and  the  Emperor  also  exempted  all 
physicians  from  the  payment  of  taxes,  and  from 
other  public  obligations. 

In  the  time  of  Augustus  natural  philosophy 
made  little  progress,  and  Virgil  strongly  desired  its 
advancement.  Human  anatomy,  as  a  study,  had 
not  been  introduced,  and  physiology  was  almost 
unknown.  In  medicine,  the  standard  of  practice 
was  the  writings  of  Hippocrates,  and  the  Materia 
Medica  consisted  of  remedies  suggested  by  the 
whimsical  notions  of  their  inventors. 

Pliny  wrote  that  the  water  cure  was  the  principal 
remedy   in  his  day,  as  it  was   indeed  throughout 

'  Suetonius  :  "  Lives  of  the  Csesars,"  Ixxxii. 


66  GEEEK  AND   ROMAN   MEDICINE 

the  Empire,  and  it  was  certainly  the  most  popular. 
Seneca  was  very  severe  on  the  sentiment  of  a  poem 
written  by  Maecenas,  the  friend  and  counsellor  of 
Augustus,  but  it  serves  to  reveal  some  of  the  most 
dreaded  maladies  of  the  time  : — 

"  Though  racked  with  gout  in  hand  and  foot, 
Though  cancer  deep  should  strike  its  root, 
Though  palsy  shake  my  feeble  thighs, 
Though  hideous  lump  on  shoulder  rise, 
From  flaccid  gum  teeth  drop  away ; 
Yet  all  is  well  if  life  but  stay." 

Malaria    was    one    of    the    principal   causes   o 
mortality   in    and    near    Kome   in   the    reign    of 
Augustus  Caesar. 

Augustus's  fatal  illness  occurred  in  a.d.  14  from 
chronic  diarrhoea,  and  the  Emperor,  like  the  true 
Eoman  that  he  was,  displayed  great  calmness  and 
fortitude  in  his  last  days. 

Tiberius  succeeded  to  the  throne  in  a.d.  14,  and 
began  a  career  of  infamy.  How  little  knowledge 
was  likely  to  gain  from  his  patronage  is  shown  by 
the  fact,  recorded  by  Pliny,  that  the  shop  and  tools 
of  the  artist  who  discovered  how  to  make  glass 
malleable  were  destroyed.  Assassins  and  perpe- 
trators of  every  abomination  were  the  fit  com- 
panions of  this  tyrant. 

Thrasyllus,  the  astrologer,  lived  with  Tiberius, 
who  was  a  firm  believer  in  the  magic  arts.  This 
reign  is  made  illustrious  in  the  history  of  medicine 
by  the  work  of  Celsus. 


IN   THE   EEIGN   OF   THE   C^SAKS  67 

Caligula,  who  became  Emperor  in  a.d.  34,  was 
guilty  of  the  most  inhuman  conduct.  Criminals 
were  given  to  the  wild  beasts  for  their  food,  and 
even  people  of  honourable  rank  had  their  faces 
branded  with  hot  irons  as  a  punishment  by  order 
of  this  mad  tyrant. 

Claudius,  the  successor  of  Caligula,  completed 
some  very  important  public  works  in  his  reign, 
including  great  aqueducts  and  drains,  but  learning 
was  at  a  low  ebb  in  his  day.  Claudius  Etruscus, 
the  freedman  of  the  Emperor  Claudius,  erected 
baths  referred  to  by  Martial.  The  ruins  of  the 
arches  of  the  Aqua  Claudia  still  remain. 

Thrasyllus,  a  son  of  the  astrologer  who  lived  in 
the  time  of  Tiberius,  is  said  to  have  predicted  to 
Nero  the  dignity  of  the  purple.  Nero  would  have 
been  favourably  disposed  towards  physicians  if  he 
had  heeded  the  advice  of  his  tutor,  Seneca,  who 
wrote :  "  People  pay  the  doctor  for  his  trouble ; 
for  his  kindness  they  still  remain  in  his  debt." 
"  Great  reverence  and  love  is  due  to  both  the 
teacher  and  the  doctor.  We  have  received  from 
them  priceless  benefits ;  from  the  doctor,  health 
and  life ;  from  the  teacher,  the  noble  culture  of  the 
soul.  Both  are  our  friends,  and  deserve  our  most 
sincere  thanks,  not  so  much  by  their  merchantable 
art,  as  by  their  frank  goodwill."  ^  The  practice  of 
necromancy  in  the  time  of  Nero  had  grown  to  such 

1  Seneca  "  De  Benefic,"  vi. 


68  GREEK  AND   EOMAN   MEDICINE 

an  extent  that  an  edict  of  banishment  was  issued 
against  all  magicians,  but  this  did  not  lessen  the 
popularity  of  the  magicians,  who  indeed  prospered 
under  the  semblance  of  persecution,  and  were 
honoured  in  times  of  public  difficulty  and  danger. 
The  practice  of  astrology  came  from  the  Chaldeans, 
and  was  introduced  into  Greece  in  the  third 
century  before  Christ.  It  was  accepted  by  all 
classes,  but  specially  by  the  Stoic  philosophers. 
In  319  B.C.,  Cornelius  Hispallus  banished  the 
Chaldeans  from  Eome,  and  ordered  them  to  leave 
Italy  within  ten  days.  In  33  B.C.,  they  were  again 
banished  by  Marcus  Agrippa,  and  Augustus  also 
issued  an  edict  against  them.  They  were  punished 
sometimes  by  death,  and  their  calling  must  have 
been  lucrative  to  induce  them  to  continue  in  spite 
of  the  severe  punishments  to  which  they  made 
themselves  liable.  The  penal  laws  against  them, 
however,  were  in  operation  only  intermittently. 
They  were  consulted  by  all  classes,  from  the 
Emperor  downwards. 

There  were  many  physicians  in  the  reign  of 
Nero,  but  none  of  great  eminence.  Andromachus 
was  physician  to  the  Emperor,  and  had  the  title 
of  archiater,  which  means  "  chief  of  the 
physicians." 

An  account  of  the  archiaters  is  of  interest. 
The  name  was  applied  to  Christ  by  St.  Jerome. 
There  were  two  classes  of  archiaters  in  time,  the 
one  class  called  arcliiatri  sancti  palati ;  the  other,. 


IN   THE   EEIGN   OF   THE   C^SAES  69 

archiatri  populares.  The  former  attended  the 
Emperor,  and  were  court  physicians;  the  latter 
attended  the  people.  Although  Nero  appointed 
the  first  archiater,  the  name  is  not  commonly  used 
in  Latin  until  the  time  of  Constantine,  and  the 
division  into  two  classes  probably  dates  from  about 
that  time.  The  archiatri  sancti  palati  were 
of  high  rank,  and  were  the  judges  of  disputes 
between  physicians.  The  Archiatri  had  many 
privileges  conferred  upon  them.  They,  and  their 
wives  and  children,  did  not  have  to  pay  taxes. 
They  were  not  obliged  to  give  lodgings  to  soldiers 
in  the  provinces,  and  they  could  not  be  put  in 
prison.  These  privileges  applied  more  especially 
to  the  higher  class.  When  an  archiater  sancti 
palati  ceased  attendance  on  the  Emperor  he  took 
the  title  of  ex-archiater.  The  title  comes  archia- 
torum  means  "  count  of  the  Archiatri,"  and  gave 
rank  among  the  high  nobility  of  the  Empire. 

The  archiatri  populares  attended  the  sick  poor, 
and  each  city  had  five,  seven  or  ten,  according  to 
its  size.  Kome  had  fourteen  of  these  officers, 
besides  one  for  the  vestal  virgins,  and  one  for  the 
gymnasia.  They  were  paid  by  the  Government 
for  attending  the  poor,  but  were  not  restricted  to 
this  class  of  practice,  and  were  well  paid  by 
their  prosperous  patients.  Their  office  was  more 
lucrative  but  not  so  honourable  as  that  of  the 
archiaters  of  the  palace.  The  archiatri  'populares 
were  elected  by  the  people  themselves. 


70  GEEEK  AND   KOMAN   MEDICINE 

Suetonius  describes  the  treatment  Neto  under- 
went for  the  improvement  of  his  voice :  "  He 
would  lie  upon  his  back  with  a  sheet  of  lead  upon 
his  breast,  clear  his  stomach  and  bowels  by  vomits 
and  clysters,  and  forbear  the  eating  of  fruits,  or 
food  prejudicial  to  his  voice."  He  built,  at  great 
expense,  magnificent  public  baths  supplied  from 
the  sea  and  from  hot  springs,  and  was  the  first  to 
build  a  public  gymnasium  in  Eome. 

There  is  reason  to  believe  that  in  the  time  of  Nero 
there  was  a  class  of  women  poisoners.  Nero 
employed  one  of  these  women,  Locusta  by  name, 
and  after  she  had  poisoned  Britannicus,  rewarded 
her  with  a  great  estate  in  land,  and  placed  disciples 
with  her  to  be  instructed  in  her  nefarious  trade. 

There  was  also  a  very  ignorant  class  of  oculists 
in  Kome  in  the  time  of  Nero,  but  at  Marseilles 
Demosthenes  Philalethes  was  deservedly  celebrated, 
and  his  book  on  diseases  of  the  eye  was  in  use  for 
several  centuries.  The  eye  doctors  of  Eome 
employed  ointments  almost  entirely,  and  about 
two  hundred  seals  have  been  discovered  which  had 
been  attached  to  pots  of  eye  salves,  each  seal 
bearing  the  inventor's  and  proprietor's  name. 
In  the  time  of  Galen,  these  quack  oculists  were 
very  numerous,  and  Galen  inveighs  against  them. 
Martial  satirized  them :  "  Now  jou.  are  a  gladiator 
who  once  were  an  ophthalmist ;  you  did  as  a 
doctor  what  you  do  as  a  gladiator."  "  The  blear- 
eyed  Hylas    would  have   paid  you    sixpence,    O 


IN   THE   EEIGN   OF  THE   C^SAES  71 

Quintus ;  one  eye  is  gone,  he  will  still  pay  three- 
pence ;  make  haste  and  take  it,  brief  is  your  chance ; 
when  he  is  blind,  he  will  pay  you  nothing."  The 
oculists  of  Alexandria  were  very  proficient,  and 
some  of  their  followers,  at  various  times  through- 
out the  period  of  the  Roman  Empire,  were  remark- 
ably skilful.  Their  literature  has  perished,  but  it 
is  believed  that  they  were  able  to  operate  on 
cataract. 

With  the  death  of  Nero  in  a.d.  68,  the  direct 
line  of  the  Caesars  became  extinct. 


72 


CHAPTEE  VII. 

PHYSICIANS  FEOM  THE    TIME   OF  AUGUSTUS   TO 
THE  DEATH  OF  NERO. 

Celsus — His  life  and  works — His  influence  on  Medicine — 
Meges  of  Sidon — Apollonius  of  Tyana — Alleged  miracles 
— Vettius  Valleus — Scribonius  Longus — Andromachus — 
Thessalus  of  Tralles — Pliny. 

AuLUS  Cornelius  Celsus  lived  in  the  reigns 
of  Augustus  and  Tiberius.  References  in  his  works 
show  that  he  either  lived  at  the  same  time  as 
Themison  or  shortly  after  him.  Verona  has  been 
claimed  as  his  birthplace,  but  the  purity  of  his 
literary  style  shows  that  he  lived  for  a  considerable 
time  in  Rome,  and  he  was  probably  educated  there. 
In  Pliny's  account  of  the  history  of  medicine, 
Celsus  is  not  mentioned  as  having  practised  in 
Rome,  and  it  is  almost  certain  that  he  combined 
the  practice  of  medicine  with  the  study  of  science 
and  literary  pursuits ;  his  practice  was  not  general, 
but  restricted  to  his  friends  and  dependents. 
His  writings  show  that  he  had  a  clinical  know- 
ledge of  disease  and  a  considerable  amount  of 
medical  experience.  He  wrote  not  only  on  medi- 
cine but  also  on  history,  philosophy,  jurisprudence 
and  rhetoric,  agriculture  and  military  tactics. 
His   great   medical   work,    "De   Medicina,"   com- 


PHYSICIANS  FROM  AUGUSTUS  TO  DEATH  OF  NERO   73 

prises  eight  books.  He  properly  begins  with 
the  history  of  medicine,  and  then  proceeds  to 
discuss  the  merits  of  the  controversy  between  the 
Dogmatici  and  the  Empirici.  The  first  two  books 
deal  with  general  principles  and  with  diet,  and  the 
remaining  books  with  particular  diseases ;  the  third 
and  fourth  with  internal  diseases,  the  fifth  and 
sixth  with  external  diseases  and  pharmacy,  and 
the  last  two  are  surgical,  and  of  great  merit  and 
importance.  In  his  methods  of  treatment  there 
can  be  discerned  the  influence  of  Asclepiades  of 
Prusa,  and  the  Hippocratic  principle  of  aiding 
rather  than  opposing  nature,  but  some  of  his  work 
displays  originality.  His  devotion  to  Hippocrates 
hindered  very  much  the  exercise  of  his  own  powers, 
and  set  a  bad  example,  in  this  respect,  to  his 
successors. 

He  was  rather  free  in  the  use  of  the  lancet,  but 
not  to  the  same  extent  as  his  contemporaries,  and 
he  advocated  the  use  of  free  purgation  as  well  as 
bleeding.  He  never  could  rid  his  mind  of  the 
orthodox  humoral  theories  of  his  predecessors. 

(1)  Surgery. — Although  Celsus  is  the  first  writer 
in  Kome  to  deal  fully  with  surgical  procedures,  it 
must  not  be  inferred  that  the  practice  of  this  art 
began  to  be  developed  in  his  time,  for  surgery  was 
then  much  more  advanced  than  medicine.  Many 
major  operations  were  performed,  and  it  is  very 
instructive  for  doctors  of  the  present  day  to  learn 
that   much   that  is  considered   modern  was  well 


.74  GREEK  AND   EOMAN   MEDICINE 

understood  by  tlie  ancients.  There  is  no  greater 
fallacy  than  to  suppose  that  medical  practice 
general^,  and  surgery  in  particular,  has  reached 
no  eminence  except  in  Tery  recent  times.  The 
operation  of  crushing  a  stone  in  the  bladder  was 
devised  at  Alexandria  by  Ammonius  Lithotomos, 
(287  B.C.),  and  is  thus  described  by  Celsus  : — 

"  A  hook  or  crotchet  is  fixed  upon  the  stone  in 
such  a  way  as  easily  to  hold  it  firm,  even  when 
shaken,  so  that  it  may  not  revolve  backward ;  then 
an  iron  instrument  is  used,  of  moderate  thickness, 
thin  at  the  front  end  but  blunt,  which,  when 
applied  to  the  stone  and  struck  at  the  other  end, 
cleaves  it.  Great  care  must  be  taken  that  the 
instrument  do  not  come  into  contact  with  the 
bladder  itself,  and  that  nothing  fall  upon  it  by  the 
breaking  of  the  stone." 

Celsus  describes  plastic  operations  for  the  repair 
of  the  nose,  lips  and  ears,  though  these  operations 
are  generally  supposed  to  have  been  recently 
devised. 

He  describes  lithotomy,  and  operations  upon 
the  eye,  as  practised  at  Alexandria,  both  probably 
introduced  there  from  India.  Subcutaneous 
urethrotomy  was  also  practised  in  his  time. 

Trephining  had  long  been  a  well-known  operation 
of  surgery.  There  is  an  account  in  detail  of  how 
amputation  should  be  performed. 

The  teaching  of  Celsus  in  reference  to  disloca- 
tions and  fractures  is  remarkably  advanced.     Dis- 


PHYSICIANS  FROM  AUGUSTUS  TO  DEATH  OF  NERO   75 

locations,  he  points  out,  should  be  reduced  before 
inflammation  sets  in,  and  in  failure  of  union  of 
fractures,  he  recommends  extension  and  the  rubbing 
together  of  the  ends  of  the  broken  bone  to  promote 
union.  If  necessary,  after  minor  measures  have 
failed  to  promote  union,  he  recommends  an  incision 
down  to  the  ends  of  the  bones,  and  the  open 
incision  and  the  fracture  will  heal  at  the  same 
time. 

It  is  interesting  to  find  that  Celsus  knew  of  the 
danger  of  giving  purgatives  in  strangulated  rupture 
of  the  bowels.  For  uncomplicated  rupture  he 
recommends  reduction  by  taxis  and  operation. 
Cauterization  of  the  canal  is  part  of  the  operation. 
He  also  gives  careful  directions  for  removing 
foreign  bodies  from  the  ears. 

Celsus  writes  very  fully  on  haemorrhage,  and 
describes  the  method  of  tying  two  ligatures  upon 
a  blood-vessel,  and  severing  it  between  the 
ligatures.  His  method  of  amputating  in  cases 
of  gangrene  by  a  simple  circular  incision  was  in 
use  down  to  comparatively  modern  times.  He 
describes  catheterization,  plastic  operations  on  the 
face,  the  resection  of  ribs  for  the  cure  of  sinuses  in 
the  chest  walls,  operation  for  cataract,  ear  disease 
curable  by  the  use  of  the  syringe,  and  operations 
for  goitre.  These  goitre  operations  are  generally 
supposed  to  be  a  recent  triumph  of  surgery. 

Celsus  also  had  knowledge  of  dentistry,  for  he 
writes   of   teeth  extraction  by  means  of   forceps, 


76  GEEEK  AND  ROMAN  MEDICINE 

the  fastening  of  loose  teeth  with  gold  wire,  and 
a  method  of  bursting  decayed  and  hollow  teeth 
by  means  of  peppercorns  forced  into  the  cavity. 
He  has  described  also  many  of  the  most  difficult 
operations  in  obstetrics. 

When  it  is  remembered  that  Celsus  lived  cen- 
turies before  the  introduction  of  chloroform  and 
ether,  it  is  wonderful  to  contemplate  what  was 
accomplished  long  ago. 

The  qualities  which  should  distinguish  a  surgeon 
were  described  by  Celsus  thus  :  "  He  should  not  be 
old,  his  hand  should  be  firm  and  steady,  and  he 
should  be  able  to  use  his  left  hand  equally  with 
his  right ;  his  sight  should  be  clear,  and  his  mind 
calm  and  courageous,  so  that  he  need  not  hurry 
during  an  operation  and  cut  less  than  required, 
as  if  the  screams  of  the  patient  made  no  impres- 
sion upon  him." 

(2)  Anatomy. — Celsus  understood  fairly  well  the 
situation  of  the  internal  organs,  and  knew  well 
the  anatomy  of  the  chest  and  female  pelvis.  His 
knowledge  of  the  skeleton  was  particularly  com- 
plete and  accurate.  He  describes  very  fully  the 
bones  of  the  head,  including  the  perforated  plate 
of  the  ethmoid  bone,  the  sutures,  the  teeth, 
and  the  skeletal  bones  generally.  Portal  states 
that  Celsus  knew  of  the  semicircular  canals.  He 
understood  the  structure  of  the  joints,  and  points 
out  that  cartilage  is  part  of  their  formation. 

Celsus  wrote  :  "  It  is  both  cruel  and  superfluous 


PHYSICIANS  FEOM  AUGUSTUS  TO  DEATH  OF  NEEO   77 

to  dissect  the  bodies  of  the  hving,  but  to  dissect 
those  of  the  dead  is  necessary  for  learners,  for 
they  ought  to  know  the  position  and  order  which 
dead  bodies  show  better  than  a  hving  and  wounded 
man.  But  even  the  other  things  which  can  only 
be  observed  in  the  living,  practice  itself  will  show 
in  the  cures  of  the  wounded,  a  little  more  slowly 
but  somewhat  more  tenderly." 

(3)  Medicine. — His  treatment  of  fevers  was  ex- 
cellent, for  he  recognized  that  fever  was  an  effort 
of  Nature  to  throw  off  morbid  materials.  His 
recipes  are  not  so  complicated,  but  more  sensible 
and  effective  than  those  of  his  immediate 
successors.  He  understood  the  use  of  enemas 
and  artificial  feeding.  In  cases  of  insanity  he 
recognized  that  improvement  followed  the  use  of 
narcotics  in  the  treatment  of  the  accompanying 
insomnia.  He  recognized  also  morbid  illusions. 
He  recommended  lotions  and  salves  for  the  treat- 
ment of  some  eye  diseases. 

Although  Celsus  practised  phlebotomy,  he  dis- 
countenanced very  strongly  its  excessive  use.  The 
physicians  in  Eome,  in  his  time,  carried  bleeding 
to  great  extremes.  "  It  is  not,"  wrote  Celsus,  "  a 
new  thing  to  let  blood  from  the  veins,  but  it  is 
new  that  there  is  scarcely  a  malady  in  which  blood 
is  not  drawn.  Formerly  they  bled  young  men, 
and  women  who  were  not  pregnant,  but  it  had 
not  been  seen  till  our  days  that  children,  pregnant 
women,  and  old  men  were  bled."     The  reason  for 


78  GREEK  AND   ROMAN   MEDICINE 

bleeding  the  strong  and  plethoric  was  to  afford 
outlet  to  an  excessive  supply  of  blood,  and  the 
weak  and  ansemic  were  similarly  treated  to  get 
rid  of  evil  humours,  so  that  hardly  any  sick  person 
could  escape  this  drastic  treatment. 

Emetics  were  greatly  used  in  the  time  of  Celsus. 
Voluptuaries  made  use  of  them  to  excite  an 
appetite  for  food,  and  they  used  them  after  eating 
heavy  meals  to  prepare  the  stomach  for  a  second 
bout  of  gluttony.  Many  gourmands  took  an 
emetic  daily.  Celsus  said  that  emetics  should 
not  be  used  as  a  frequent  practice  if  the  attain- 
ment of  old  age  was  desired. 

Celsus  excelled  as  a  compiler,  and  had  the 
faculty  of  selecting  the  most  admirable  contribu- 
tions to  the  art  of  healing  from  previous  medical 
writers.  His  writings  also  give  an  account  of 
what  was  best  in  the  medical  practice  of  Eome 
about  his  own  time.  He  had  a  great  love  for 
learning,  and  it  is  remarkable  that  he  was  attracted 
to  the  -study  of  medicine,  for  he  was  a  patrician, 
and  members  of  his  class  considered  study  of  that 
kind  beneath  the  dignity  of  their  rank. 

In  the  Augustan  age,  when  literature  in  Eome 
reached  its  highest  level,  the  literary  style  of 
Celsus  was  fit  to  be  classed  with  that  of  the 
great  writers  of  his  time.  He  was  never  quoted 
as  a  great  authority  on  medicine  or  surgery  by 
later  medical  writers ;  and  Pliny  refers  to  him  as 
a  literary  man,  and  not  as  a  practising  physician. 


PHYSICIANS  FROM  AUGUSTUS   TO   DEATH   OF   NERO      79 

From  the  fact  that  he  elaborated  no  new  system, 
and  founded  no  new  medical  sect,  it  is  not  strange 
that  he  had  no  disciples. 

In  later  centuries  his  works  were  used  as  a 
textbook  for  students,  not  only  for  the  informa- 
tion they  supplied,  but  also  because  of  their 
excellence  as  literature. 

Parts  of  the  foregoing  synopsis  of  the  writings 
of  Celsus  are  drawn  from  the  writings  of 
Hermann  Baas  and  of   Berdoe. 

Meges  of  Sidon  (20  e.g.)  was  a  famous  surgeon 
who  practised  in  Eome  shortly  before  the  time  of 
Celsus.  He  was  regarded  by  Celsus  as  the  most 
skilful  surgeon  of  that  period,  and  his  works,  of 
which  nothing  now  remains,  were  quoted  by 
Celsus,  and  also  referred  to  by  Pliny.  Meges  was 
a  follower  of  Themison.  He  is  said  to  have 
invented  instruments  used  in  cutting  for  stone, 
and  he  wrote  on  tumours  of  the  breast  and  dislo- 
cation of  the  knee.  There  have  been  several 
famous  doctors  called  Eudemus.  One  of  these  was 
an  anatomist  in  the  third  century  before  Christ, 
and  a  contemporary,  according  to  Galen,  of  Hero- 
philus  and  Erasistratus.  He  gave  great  attention 
to  the  anatomy  and  physiology  of  the  nervous 
system.  There  was,  however,  another  Eudemus, 
a  physician  of  Eome,  who  became  entangled  in  an 
intrigue  with  the  wife  of  the  son  of  the  Emperor 
Tiberius.  He  aided  her  in  an  attempt  to  poison 
her  husband  in  a.d.  23.  He  was  put  to  torture, 
and  finally  executed  by  order  of  Tiberius. 


80  GREEK  AND  ROMAN  MEDICINE 

Apollonius  of  Tyana  was  born  four  years  before 
the  Christian  era,  in  the  time  of  Augustus  Caesar, 
and  is  known  chiefly  for  the  parallel  that  has  been 
drawn  by  ancient  and  modern  ^writers  between  his 
supposed  miracles  and  those  of  the  Saviour.  His 
doings  as  described  by  Philostratus  are  extra- 
ordinary and  incredible,  and  he  was  put  forward  by 
the  Eclectics  in  opposition  to  the  unique  powers 
claimed  by  Christ  and  believed  in  by  His  followers. 
Apollonius  is  said  to  have  studied  the  philosophy 
of  the  Platonic,  Sceptic,  Epicurean,  Peripatetic 
and  Pythagorean  schools,  and  to  have  adopted 
that  of  Pythagoras.  He  schooled  himself  in  early 
manhood  in  the  asceticism  of  that  philosophy.  He 
abstained  from  animal  food  and  strong  drink,  wore 
white  linen  garments  and  sandals  made  of  bark, 
and  let  his  hair  grow  long.  For  five  years  he 
preserved  a  mystic  silence,  and  during  this  period 
the  truths  of  philosophy  became  known  to  him. 
He  had  interviews  with  the  Magi  in  Asia  Minor, 
and  learned  strange  secrets  from  the  Brahmans  in 
India.  In  Greece  he  visited  the  temples  and 
oracles,  and  exercised  his  powers  of  healing.  Like 
Pythagoras,  he  travelled  far  and  wide,  disputing 
about  philosophy  wherever  he  went,  and  he  gained 
an  extraordinary  reputation  for  magical  powers. 
The  priests  of  the  temples  gave  him  divine  honours 
and  sent  the  sick  to  him  to  be  cured.  He  arrived 
in  Rome  just  after  an  edict  had  been  promulgated 
by  Nero  against  magicians.     He  was  tried  before 


PHYSICIANS  FROM  AUGUSTUS  TO  DEATH  OF  NERO   81 

Telesinus,  the  consul,  and  Tigellinus,  the  base 
favourite  of  the  Emperor.  He  was  acquitted  by 
Telesinus  because  of  his  love  of  philosophy,  and 
by  Tigellinus  because  of  his  fear  of  magic.  Sub- 
sequently, at  Alexandria,  Apollonius,  in  virtue  of 
his  magic  power,  affirmed  that  he  would  make 
Vespasian  emperor,  and  afterwards  became  the 
friend  of  Titus,  Vespasian's  son.  On  the  accession 
of  Domitian,  Apollonius  stirred  up  the  provinces 
against  him,  and  was  ordered  to  be  brought  in 
custody  to  Eome,  but  he  surrendered  himself  to  the 
authorities,  and  was  brought  into  the  presence  of 
the  Emperor  to  be  questioned.  He  began  to  praise 
Nerva,  and  was  immediately  ordered  to  prison  and 
to  chains.  It  is  said  that  he  miraculously  escaped, 
and  spent  the  remainder  of  his  days  in  Ephesus. 

The  relation  of  Apollonius  to  the  art  of  medicine 
is  connected  with  his  visits,  on  his  travels,  to  the 
temples  of  ^sculapius,  and  his  healing  of  the  sick 
and  alleged  triumph  over  the  laws  of  Nature.  He 
was  also  credited  with  raising  the  dead,  casting 
out  devils  and  other  miracle-working  that  appears 
to  have  been  borrowed  from  the  life  of  Christ.  No 
doubt  he  was  a  genuine  philosopher  and  follower  of 
Pythagoras.  His  history  is,  on  the  whole,  worthy 
of  belief,  except  the  part  relating  to  miracles.  It 
is  noteworthy  that  he  did  not  claim  for  himself 
miraculous  power.  Newman  in  his  '*  Life  of 
Apollonius  "  takes  the  view  that  the  account  of  the 
miracles  of  Apollonius  is  derived  from  the  narrative 
6 


82  GREEK  AND   EOMAN   MEDICINE 

of  Christ's  miracles,  and  has  been  concocted  by 
people  anxious  to  degrade  the  character  of  the 
Saviour.  The  attempt  to  make  him  appear  as  a 
pagan  Christ  has  been  renewed  in  recent  years. 

In  the  realm  of  medical  practice  he  succeeded 
by  imposture  probably,  but  also  in  a  genuine  way 
by  means  of  suggestion,  and  no  doubt  he  had  also 
acquired  medical  knowledge  from  study  and  travel- 
ling among  people  who  had  healing  powers  and 
items  of  medical  knowledge  perhaps  unknown  at 
the  present  day. 

Vettius  {or  Vectius)  Valleus,  was  of  equestrian 
rank  but  he  did  not  confer  any  honour  on  the 
medical  profession.  He  was  one  of  the  lewd  com- 
panions of  Messalina,  the  wife  of  the  Emperor 
Claudius,  and  was  put  to  death  in  a.d.  48.  He 
was  a  believer  in  Themison's  doctrines,  and  is  said 
by  Pliny^  to  have  founded  a  new  medical  sect,  but 
nearly  all  the  Methodici  attempted  to  create  a  new 
sect  by  adding  to,  or  subtracting  a  little  from,  the 
tenets  of  Methodism. 

Scribonius  Largus  (about  A.D.  45)  was  physician 
to  Claudius  and  accompanied  him  to  Britain.  He 
wrote  several  medical  books,  and  is  reputed  to  have 
used  electricity  for  the  relief  of  headaches. 

Andromaclius,  the  elder,  was  physician  to  Nero, 
and  the  first  archiater.  He  was  born  in  Crete. 
He  was   the   inventor  of   a   compound  medicine 

^  H.  N.,  xxix,  5. 


PHYSICIANS  FROM  AUGUSTUS  TO  DEATH  OF  NERO   83 

called  after  himself,  "  Theriaca  Andromachi."  He 
gave  directions  for  raaking  it  in  a  poem  of  174 
lines.  This  poem  is  quoted  by  Galen,  who  explains 
that  Andromachus  gave  his  instructions  a  poetical 
form  to  assist  memory,  and  to  prevent  the  likeli- 
hood of  alteration. 

Andromachus,  the  younger,  was  the  son  of  the 
first  archiater,  and  was,  like  his  father,  physician 
to  Nero.  He  wrote  a  book  on  Pharmacy,  in  three 
volumes. 

Thessalus  of  Tralles,  in  Lydia,  lived  in  Bome  in 
the  reign  of  Nero,  and  dedicated  one  of  his  books 
to  the  Emperor.  He  was  a  charlatan  with  no 
medical  knowledge,  but  with  a  good  deal  of  ability 
and  assurance.  He  said  that  medicine  surpassed 
all  other  arts,  and  he  surpassed  all  other  physicians. 
His  father  had  been  a  weaver,  and  in  his  youth 
Thessalus  followed  the  same  calling,  and  never  had 
any  medical  training.  This  did  not  prevent  him, 
however,  from  acquiring  a  great  reputation  as  a 
doctor,  and  making  a  fortune  from  medical  prac- 
tice. At  first,  he  associated  himself  with  the 
views  of  the  Methodici,  but  afterwards  amended 
them  as  he  thought  fit,  until  he  had  convinced  the 
public,  and  perhaps  also  himself,  that  he  was  the 
founder  of  a  new  and  true  system  of  medicine. 
He  spoke  in  very  disrespectful  and  violent  terms 
of  his  predecessors,  and  said  that  no  man  before 
him  had  done  anything  to  advance  the  science  of 
medicine.   Besides  having  an  endowment  of  natural 


84  GREEK  AND  BOMAN  MEDICINE 

shrewdness  and  ability,  he  was  equipped  with  great 
powers  of  self-advertisement,  and  could  cajole  the 
rich  and  influential.  He  was  an  adept  in  the  art 
of  flattery.  Galen  often  refers  to  him,  and  always 
with  contempt.  Thessalus  was  able,  so  he  said, 
to  teach  the  medical  art  in  six  months,  and  he 
surrounded  himself  with  a  retinue  of  artisans, 
weavers,  cooks,  butchers,  and  so  on,  who  were 
allowed  to  kill  or  cure  his  patients.  Sprengel 
states  that,  after  the  time  of  Thessalus,  the  doctors 
of  Eome  forbore  to  take  their  pupils  with  them 
on  professional  visits. 

He  began  a  method  of  treatment  for  chronic 
and  obstinate  cases.  The  first  three  days  of  the 
treatment  were  given  up  to  the  use  of  vegetable 
drugs,  emetics,  and  strict  dietary.  Then  followed 
fasting,  and  finally  a  course  of  tonics  and  restora- 
tives. He  is  said  to  have  used  colchicum  for  gout. 
The  tomb  of  Thessalus  on  the  Appian  Way  was 
to  be  seen  in  Pliny's  time.  It  bore  the  arrogant 
device  "  Conqueror  of  Physicians."  The  success 
of  Thessalus  seems  a  proof  of  the  cynical  belief 
that  the  public  take  a  man's  worth  at  his  own 
estimate. 

Pliny,  the  elder,  lived  from  a.d.  23  to  79, 
dying  during  the  eruption  of  Vesuvius  when 
Pompeii  and  Herculaneum  were  destroyed.  He 
was  not  a  scientific  man,  but  was  a  pro- 
digious recorder  of  information  on  all  subjects. 
Much  of  this   information  is   inaccurate,   for  he 


PHYSICIANS  FROM  AUGUSTUS  TO  DEATH  OF  NERO   85 

was  not  able  to  discriminate  between  the  true 
and  the  false,  or  to  assign  to  facts  their  relative 
value. 

His  great  book  on  Natural  History  includes 
many  subjects  that  cannot  properly  be  considered 
as  belonging  to  Natural  History.  It  consists  of 
thirty-six  books  and  an  index,  and  the  author 
stated  that  the  work  dealt  with  twenty  thousand 
important  matters,  and  was  compiled  from  two 
thousand  volumes. 

Although  Pliny  was  not  a  physician  he  writes 
about  medicine,  and  paints  a  picture  of  the  state 
of  medical  knowledge  of  his  time.  His  own 
opinions  on  the  subject  are  of  no  value.  He 
believed  that  magic  is  a  branch  of  medicine,  and 
was  optimistic  enough  to  hold  that  there  is  a 
score  of  remedies  for  every  disease.  His  writings 
upon  the  virtues  of  medicines  derived  from  the 
human  body,  from  fish,  and  from  plants  are  more 
picturesque  than  accurate. 


86 


CHAPTEE   YIII. 

THE  FIEST  AND   SECOND   CENTUEIES   OF  THE 
CHEISTIAN   ERA. 

Athenseus  —  Pneumatism  —  Eclectics  —  Agathinus — Aretaeus — 
Archigenes  —  Dioscorides — Cassias  Felix — Pestilence  in 
Eome  —  Ancient  surgical  instruments  —  Herodotus — 
Heliodorus  —  Cselius  Aurelianus  —  Soranus  —  Eufus  of 
Ephesus — Marinus — Quintus. 

AthencBUs^  of  Cilicia,  a  Stoic  and  Peripatetic, 
founded  in  Borne  the  sect  of  the  Pneumatists 
about  the  year  a.d.  69.  It  was  inspired  by  the 
philosophy  of  Plato.  The  pneuma,  or  spirit,  was 
in  their  opinion  the  cause  of  health  and  of  disease. 
They  believed  that  dilatation  of  the  arteries  drives 
onward  the  pneuma,  and  contraction  of  the 
arteries  drives  it  in  a  contrary  direction.  The 
pneuma  passes  from  the  heart  to  the  arteries. 
Their  theories  also  had  reference  to  the  elements. 
Thus,  the  union  of  heat  and  moisture  maintains 
health ;  heat  and  dryness  cause  acute  diseases ; 
cold  and  moisture  cause  chronic  diseases ;  cold 
and  dryness  cause  mental  depression,  and  at  death 
there  are  both  dryness  and  coldness.  In  spite  of 
these  strange  opinions  the  Pneumatists  made 
some  scientific  progress,  and  recognized  some 
diseases  hitherto  unknown.  Galen  wrote  of  the 
Pneumatists :  "  They  would  rather  betray  their 
country  than  abjure  their  opinions."      The  founder 


FIRST  AND   SECOND   CENTURIES   OF   CHRISTIAN   BRA      87 

of  the  sect  of  Pneumatists  was  a  very  prolific  writer, 
for  the  twenty-ninth  volume  of  one  of  his  works  is 
quoted  by  Oribasius.  The  teaching  of  the  Pneu- 
matists speedily  gave  way  to  that  of  the  Eclectics^ 
of  whom  Galen  was  by  far  the  most  celebrated. 
They  tried  to  reconcile  the  teaching  of  the  Dog- 
matists, Methodists,  and  Empirics,  and  adopted 
what  they  considered  to  be  the  best  teaching  of 
each  sect.  The  Eclectics  were  very  similar  to,  if 
not  identical  with,  the  Episynthetics,  founded  by  a 
pupil  of  Athenaeus,  by  name,  Agathinus.  He  was 
a  Spartan  by  birth.  He  is  frequently  quoted  by 
Galen,  but  none  of  his  writings  are  extant. 

AretcBUs,  the  Cappadocian,  practised  in  Rome 
in  the  first  century  of  our  era,  in  the  reign  of  Nero 
or  Vespasian.  He  published  a  book  on  medicine, 
still  extant,  which  displays  a  great  knowledge  of 
the  symptoms  of  disease  very  accurately  described, 
and  reliable  for  purposes  of  diagnosis.  He  was  the 
first  to  reveal  the  glandular  nature  of  the  kidneys, 
and  for  the  first  time  employed  cantharides  as  a 
counter-irritant  (Portal,  vol.  i,  p.  62).  It  is  not 
surprising  that  Aretaeus  followed  rather  closely  the 
teaching  of  Hippocrates,  but  he  considered  it  right 
to  check  some  of  "  the  natural  actions "  of  the 
body,  which  Hippocrates  thought  were  necessary 
for  the  restoration  of  health.  He  was  not  against 
phlebotomy,  and  used  strong  purgatives  and  also 
narcotics.  He  was  less  tied  to  the  opinions  of  any 
sect  than  the  physicians  of  his  time,  and  was  both 


88  GREEK  AND  EOMAN   MEDICINE 

wonderfully  accurate  in  his  opinions  and  reliable  in 
treatment.  Aretaeus  condemned  the  operation  of 
tracheotomy  first  proposed  by  Asclepiades,  and  held 
"  that  the  heat  of  the  inflammation  becomes  greater 
from  the  wound  and  contributes  to  the  suffocation, 
and  the  patient  coughs ;  and  even  if  he  escapes  this 
danger,  the  lips  of  the  wound  do  not  unite,  for  both 
are  cartilaginous  and  unable  to  grow  together."  He 
believed,  also,  that  elephantiasis  was  contagious. 
The  writings  of  Aretaeus  consist  of  eight  books,  and 
there  have  been  many  editions  in  various  languages. 
Only  a  few  chapters  are  missing. 

Archigenes  was  a  pupil  of  Agathinus,  and  is 
mentioned  by  Juvenal.  He  was  born  in  Syria  and 
practised  in  Eome  in  the  reign  of  Trajan,  a.d.  98-117. 
He  introduced  new  and  very  obscure  terms  into  his 
writings.  He  wrote  on  the  pulse,  and  on  this  Galen 
wrote  a  commentary.  He  also  proposed  a  classifi- 
cation of  fevers,  but  his  views  on  this  subject  were 
speculative  theories,  and  not  based  upon  practical 
experience  and  observation.  To  him  is  due  the 
credit  of  suggesting  opium  for  the  treatment  of 
dysentery,  and  he  also  described  accurately  the 
symptoms  and  progress  of  abscess  of  the  liver.  By 
some  authorities  he  is  thought  to  have  belonged  to 
the  sect  of  the  Pneumatici. 

Dioscorides  was  the  author  of  a  famous  treatise 
on  Materia  Medica.  At  different  times  there  were 
several  physicians  of  this  name.  He  lived  shortly 
after  Pliny  in  the  first  century,  but  there  is  some 


FIRST  AND   SECOND   CENTUEIES   OF    CHRISTIAN  ERA      89 

doubt  as  to  the  exact  time.  His  five  books  were 
the  standard  work  on  Materia  Medica  for  many- 
centuries  after  his  death.  He  compiled  an  account 
of  all  the  materials  in  use  medicinally,  and  gave  a 
description  of  their  properties  and  action.  This 
entailed  great  knowledge  and  industry,  and  is  of 
value  as  showing  what  drugs  were  used  in  his  time. 
Since  then  practically  the  whole  of  Materia  Medica 
has  been  changed.  He  held  largely  to  the  orthodox 
beliefs  of  Dogmatism,  but  a  great  deal  of  what  he 
recommends  is  not  comprised  in  the  doctrines  of 
this  sect,  and  is  decidedly  Empirical.  It  is  difficult 
or  impossible  to  identify  many  of  the  drugs  referred 
to  by  Dioscorides,  partly  because  his  descrip- 
tions are  brief,  partly  because  the  mistakes  of  his 
predecessors  are  found  in  his  book. 

He  exercised  as  much  authority  in  Materia  Medica 
as  Galen  did  in  the  practice  of  medicine,  and  the 
successors  of  each  were  content,  in  the  main,  to 
follow  blindly.  A  large  work  was  published  in 
England  in  1806  to  illustrate  the  plants  of  Greece 
described  in  the  treatises  of  Dioscorides. 

Cassius  Felix  is  supposed  to  have  lived  in  the 
first  century  of  our  era,  but  practically  nothing  is 
known  of  his  history.  He  wrote  a  book  on  medicine 
consisting  of  eighty-four  questions  on  medical  and 
physical  subjects  and  the  answers  to  them. 

In  A.D.  79,  after  the  eruption  of  Vesuvius,  there 
was  a  great  pestilence  in  Eome,  which  historians 
ascribed  to  the  pollution  of  the  air  by  the  eruption. 


90  GREEK  AND   ROMAN   MEDICINE 

Fugitives  crowded  into  Eome  from  the  devastated 
part  of  the  country,  and  there  was  great  poverty 
and  an  accumulation  of  filth  in  the  city,  which 
was,  doubtless,  the  true  cause  of  the  pestilence. 
Treatment  of  fever  at  that  time  was  very  imperfect 
at  the  best,  and  proper  means  of  prevention  and 
treatment  were  entirely  absent  in  time  of  pestilence. 
It  has  been  computed  that  ten  thousand  people 
died  daily  at  that  time  in  Eome  and  the  surround- 
ing district.  Excavations  at  Pompeii  have  done  a 
great  deal  to  reveal  the  state  of  surgical  knowledge 
towards  the  end  of  the  first  century  of  our  era. 
Professor  Vulpes  has  written  an  account  of  the 
surgical  instruments  recovered  from  the  ruins,  and 
there  is  a  collection  of  ancient  surgical  instruments 
in  the  Naples  museum.  Vaginal  and  rectal  specula 
have  been  found :  also  a  forceps  for  removing 
fractured  pieces  of  bone  from  the  surface  of  the 
brain.  There  is  an  instrument  considered  by 
Professor  Vulpes  to  have  been  used  as  an  artery 
forceps.  Other  instruments  discovered  are  : 
Forceps  for  removing  tumours ;  instruments  for 
tapping  in  cases  of  dropsy  (such  an  instrument 
was  described  by  Celsus) ;  seven  varieties  of 
probes ;  bronze  catheters ;  89  specimens  of  pincers ; 
various  kinds  of  knives,  bone-elevators,  lancets, 
spatulas,  cauteries,  saws,  and  trephines.^ 

^  For  full  description  and  plates  see  Dr.  John  Stewart 
Milne's  "  Surgical  Instruments  in  Greek  and  Eoman  Times  " 
(Clarendon  Press,  1907). 


FIRST  AND   SECOND   CENTURIES   OF    CHRISTIAN   ERA      91 

There  were  several  physicians  and  surgeons  of 
the  name  of  Herodotus.  A  famous  surgeon  of  that 
name  lived  in  Eome  about  a.d.  100.  He  was  a 
pupil  of  Athenaeus,  and  is  quoted  by  Galen  and 
Oribasius.  This  Herodotus,  according  to  Baas, 
was  the  discoverer  of  pomegranate  root  as  a  remedy 
for  tapeworm. 

Heliodorus  was  a  famous  surgeon  of  Eome,  and 
lived  about  the  same  time  as  Herodotus.  He  was 
the  contemporary  of  Juvenal.  He  performed 
internal  urethrotomy,  and  wrote  on  amputations, 
injuries  of  the  head,  and  hernia. 

CcbUus  Aurelianus  probably  lived  in  the  first 
century  of  the  Christian  era,  but  some  writers 
believe  that  he  was  a  contemporary  of  Galen  and 
a  rival,  because  the  one  never  mentions  nor  is 
mentioned  by  the  other ;  but  this  view  is  unneces- 
sarily severe  upon  the  standard  of  medical  ethics 
attained  by  the  leaders  of  the  profession  in  early 
times.  From  the  style  of  his  writings,  it  has  been 
deduced  that  CEelius  Aurelianus  was  not  a  native 
of  Greece  or  of  Kome.  He  belonged  strictly  to 
the  sect  of  the  Methodici,  and  his  writings  are 
important  as  revealing  very  fully  the  teaching  of 
this  sect.  He  mentions  some  diseases  not  pre- 
viously described,  and  had  a  good  knowledge  of 
symptoms.  He  divided  diseases  into  two  classes, 
acute  and  chronic,  or,  more  in  conformity  with  the 
terminology  of  the  Methodici,  those  of  constric- 
tion and  those  of  relaxation.     Aurelianus  did  not 


92  GREEK  AND  ROMAN   MEDICINE 

concern  himself  with  inquiring  into  the  causation 
of  diseases.  His  method  was  to  find  out  the  class 
to  which  a  disease  belonged,  and  to  treat  it 
accordingly.  He  was  very  practical  in  his  views, 
and  did  a  great  deal  to  place  treatment  upon  a 
satisfactory  basis.  His  chief  weakness  was  his 
failure  to  recognize  the  various  difierences  and 
gradations,  and  he  attached  far  too  much  import- 
ance to  the  two  classes  recognized  by  his  school. 
He  withheld  active  treatment  until  he  had  ascer- 
tained to  his  own  satisfaction  the  class  to  which 
the  disease  belonged.  Caslius  Aurelianus  wrote 
three  books  on  acute  diseases  and  five  on  chronic 
diseases.  He  cites  the  case  of  a  patient  who  was 
cured  of  dropsy  by  tapping,  and  of  a  person  who 
was  shot  through  the  lungs  with  an  arrow  and 
recovered.  He  agreed  with  Aretsus  in  condemn- 
ing tracheotomy.  His  books  are  not  written  in  a 
good  literary  style. 

Sora7ius,  of  Ephesus,  was  an  eminent  physician 
of  the  Methodist  school,  who  practised  in  Eome 
in  the  reigns  of  Trajan  and  Hadrian.  He  wrote 
a  great  work  on  diseases  of  women,  of  which  a 
G-reek  manuscript,  copied  in  the  fifteenth  century, 
was  discovered  in  La  Bibliotheque  Eoyale  in  Paris 
by  Dietz,  who  was  commissioned  by  the  Prussian 
Government  to  explore  the  public  libraries  of 
Europe.  The  same  investigator  also  discovered 
another  copy  of  the  work,  in  a  worse  state  of  pre- 
servation however,  in  the  Vatican  library.     Parts 


FIRST  AND   SECOND   CENTURIES   OF    CHRISTIAN  ERA      93 

of  the  writings  of  Soranus  are  preserved  in  the 
writings  of  Oribasius.  There  is  no  doubt  that 
Soranus  was  a  very  accompHshed  obstetrician  and 
gynaecologist.  His  description  of  the  uterus  and 
its  ligaments  and  the  displacements  to  which  the 
organ  is  liable  reveals  a  practical  knowledge  of 
anatomy.  Unlike  most  medical  writers  of  ancient 
times,  he  did  not  adopt  the  method  of  recording 
various  methods  of  treatment  copied  from  previous 
writers,  but  his  textbook  is  systematic.  In 
writing  about  a  disease  he  begins  with  a  historical 
introduction,  and  proceeds  to  describe  its  causation, 
symptoms,  and  course,  and  the  treatment  of  its 
various  phases.  His  account  of  obstetrics  shows 
that  the  art  was  well  understood  in  his  time.  His 
work  on  the  subjects  of  dystocia,  inflammation  of 
the  uterus,  and  prolapse  is  perhaps  the  best.  He 
refers  also  to  hysterectomy.  It  is  interesting  to 
note  that  he  used  the  speculum.  He  describes  the 
qualifications  of  a  good  midwife.  She  need  not 
know  very  much  anatomy,  but  should  have  been 
trained  in  dietetics,  materia  medica,  and  minor 
surgical  manipulations,  such  as  version.  She  should 
be  free  from  all  corrupt  and  criminal  practices, 
temperate,  and  not  superstitious  or  avaricious. 

In  dealing  with  the  subject  of  inversion  of  the 
uterus,  Soranus  points  out  that  this  condition  may 
be  caused  by  traction  on  the  cord.  It  is  note- 
worthy that  he  recognized  the  method  of  embryo- 
tomy as  necessary  when  other  measures  had  failed. 


94  GREEK  AND   ROMAN   MEDICINE 

In  his  time  leprosy  was  very  prevalent.  It  had 
probably  been  brought  in  the  first  place  from  the 
East  into  Italy  by  Pompey.  Some  of  the  remedies 
used  by  Soranus  for  this  disease  are  to  be  found  in 
the  works  of  Galen.  Soranus  wrote  books  on 
other  medical  subjects,  but  there  is  difficulty  in 
deciding  as  to  what  is  spurious  and  what  is  genuine 
in  the  works  attributed  to  his  authorship.  There 
were  other  physicians  of  the  same  name.  Galen 
quotes  a  book  by  Soranus  on  pharmacy,  and 
Cselius  Aurelianus  one  on  fevers.  He  is  also 
quoted  by  Tertullian,  and  by  Paulus  ^gineta,  who 
writes  that  Soranus  was  one  of  the  first  Greek 
physicians  to  describe  the  guinea-worm.  Soranus, 
in  the  opinion  of  St.  Augustine,  was  Medicines 
auctor  nohilissimus.  He  was  far  removed  from 
the  prejudices  and  superstitions  of  his  time,  as  is 
shown  by  his  denunciation  of  magical  incantations. 

Bufus,  of  Ephesus,  also  lived  in  the  reign  of 
Trajan  (a.d.  98-117).  His  books  reveal  the  state 
of  anatomical  knowledge  at  Alexandria  before  the 
time  of  Galen.  The  recurrent  nerves  were  then 
recently  discovered.  He  considered  the  spleen  a 
useless  organ.  He  understood  that  pressure  on 
the  nerves  and  not  on  the  carotid  arteries  causes 
loss  of  voice,  and  that  the  nerves  proceed  from 
the  brain,  and  are  sensory  and  motor.  The  heart, 
he  considered,  was  the  seat  of  life,  and  he  observed 
that  its  left  ventricle  is  smaller  and  thicker  than 
the  right.  The  method  of  checking  bleeding  from 
blood-vessels  by  torsion  was  known  to  him.     He 


FIRST  AND   SECOND   CENTURIES   OF   CHRISTIAN  ERA      95 

demonstrated  the  investing  membrane  of  the 
crystalline  lens  of  the  eye/  He  wrote  also  a 
treatise  in  thirty-seven  chapters  on  gout.  Many 
of  the  works  of  Eufus  are  lost,  but  fragments 
are  preserved  in  other  medical  writings. 

Marinus  was  an  anatomist  and  physician  who 
lived  in  the  first  and  second  centuries  after  Christ. 
Quintus  was  one  of  his  pupils. 

Marinus  wrote  twenty  volumes  on  anatomy,  of 
which  Galen  gives  an  abridgment  and  analysis. 
Galen  says  that  Marinus  was  one  of  the  restorers 
of  anatomical  science,  Marinus  investigated  the 
glands  and  compared  them  to  sponges,  and  he 
imagined  that  their  function  was  to  moisten 
and  lubricate  the  surrounding  structures.  He  dis- 
covered the  glands  of  the  intestines.  He  also  wrote 
a  commentary  on  the  aphorisms  of  Hippocrates. 
It  is  uncertain  if  he  is  the  Postumius  Marinus 
who  was  physician  to  the  younger  Pliny. 

Quintus  was  renowned  in  Eome  in  the  first  half 
of  the  second  century  after  Christ.  Like  Galen  he 
suffered  from  the  jealousy  and  persecution  of  his 
professional  rivals,  who  trumped  up  a  charge  against 
him  of  killing  his  patients,  and  he  had  to  flee  from 
the  city.  He  was  known  as  an  expert  anatomist, 
but  published  no  medical  writings.  It  has  been 
stated  by  some  of  the  writers  on  the  history  of 
medicine  that  Quintus  was  the  tutor  of  Galen,  but 
this  statement  is  lacking  in  definite  proof. 


Portal,"  vol.  i,  p.  74. 


96 


CHAPTER  IX. 

GALEN. 
His  life  and  works — His  influence  on  Medicine. 

Claudius  Galenus,  commonly  known  as  Galen, 
has  influenced  the  progress  of  medical  science 
by  his  writings  probably  more  than  any  other 
medical  writer.  His  influence  was  paramount  for 
fourteen  centuries,  and  although  he  made  some 
original  contributions,  his  works  are  noteworthy 
mainly  as  an  encyclopaedia  of  the  medical  know- 
ledge of  his  time  and  as  a  review  of  the  work  of  his 
predecessors.  There  is  a  great  deal  of  information 
in  his  books  about  his  own  life.  He  was  born  at 
Pergamos  in  a.d.  130  in  the  reign  of  Hadrian. 
His  father  was  a  scholar  and  his  mother  somewhat 
of  a  shrew.  Galen,  in  his  boyhood,  learned  much 
from  his  father's  example  and  instruction,  and 
at  the  age  of  15  was  taught  by  philosophers  of 
the  Stoic,  Platonist,  Peripatetic,  and  Epicurean 
schools.  He  became  initiated,  writes  Dr.  Moore, 
into  "  the  idealism  of  Plato,  the  realism  of  Aris- 
totle, the  scepticism  of  the  Epicureans,  and  the 
materialism  of  the  Stoics."  At  the  age  of  17  he 
was  destined  for  the  profession  of  medicine  by  his 
father  in   consequence  of   a  dream.     He   studied 


GALEN  97 

under  the  most  eminent  men  of  his  day.  He  went 
to  Smyrna  to  be  a  pupil  of  Pelops,  the  physician, 
and  Albinus  the  platonist ;  to  Corinth  to  study 
under  Numesianus ;  to  Alexandria  for  the  lectures 
of  Heraclianus ;  and  to  Cilicia,  Phoenicia,  Pales- 
tine, Crete,  and  Cyprus.  At  the  age  of  29  Galen 
returned  from  Alexandria  to  Pergamos  (a.d.  158), 
and  was  appointed  doctor  to  the  School  of 
Gladiators,  and  gained  much  distinction. 

He  went  to  Rome  for  the  first  time  in  a.d.  163-4, 
and  remained  for  four  years ;  and  during  this 
period  he  wrote  on  anatomy  and  on  the  teaching 
of  Hippocrates  and  Plato.  He  acquired  great  fame 
as  a  practitioner  and,  if  he  had  so  desired,  might 
have  attended  the  Emperor;  but  it  is  probable 
that  Galen  thought  that  the  office  of  physician 
to  the  Emperor  might  prevent  him  from  leaving 
Eome  if  he  wished  to  do  so.  He  also  gave  public 
lectures  and  disputations,  and  was  called  not  only 
the  "wonder-speaker"  but  the  "wonder-worker." 
His  success  gave  rise  to  envy,  and  he  was  afraid 
of  being  poisoned  by  his  less  successful  rivals. 
The  reason  why  he  left  Rome  is  not  certain,  and 
the  possible  causes  of  his  departure  are  discussed 
by  Dr.  Greenhill  in  the  "  Dictionary  of  Greek  and 
Roman  Biography  and  Mythology."  A  pestilence 
raged  in  Rome  at  this  time,  but  it  is  unlikely  that 
Galen  would  have  deserted  his  patients  for  that 
reason.  Probably  he  disliked  Rome,  and  longed  for 
his  native  place.  He  had  been  in  Pergamos  only  a 
7 


98  GREEK  AND   ROMAN   MEDICINE 

very  short  time  when  he  was  summoned  to  attend 
the  Emperors  Marcus  Aurehus  and  L.  Verus  in 
Venetia.  The  latter  died  of  apoplexy  on  his  way 
home  to  Eome,  and  Galen  followed  Marcus 
Aurelius  to  the  capital.  The  Emperor  soon  there- 
after set  out  to  prosecute  the  war  on  the  Danube, 
and  Galen  was  allowed  to  remain  in  Eome,  as  he 
had  stated  that  such  was  the  will  of  ^sculapius- 
The  Emperor's  son  Commodus  was  placed  under 
the  care  of  Galen  during  the  father's  absence,  and 
at  this  time  also  (a.d.  170)  Galen  prepared  the 
famous  medicine  theriaca  for  Marcus  Aurelius, 
who  took  a  small  quantity  daily.  The  Emperor 
Septimius  Severus  employed  the  same  physician 
and  the  same  medicine  about  thirty  years  after- 
wards. It  is  recorded  that  the  philosopher 
Eudemius  was  successfully  treated  by  Galen  for 
a  severe  illness  caused  by  an  overdose  of  theriaca, 
and  that  the  treatment  employed  was  the  same 
drug  in  small  doses. 

Galen  stayed  several  years  in  Eome,  and  wrote 
and  practised  as  on  his  former  visit.  He  again 
returned  to  Pergamos,  and  probably  was  in  Eome 
again  at  the  end  of  the  second  century.  It  is 
certain  he  was  still  alive  in  the  year  199,  and 
probably  lived  in  the  reign  of  the  Emperor 
Caracalla. 

He  was  not  only  a  great  physician,  but  a  man 
of  wide  culture  in  every  way.  In  matters  of  re- 
ligion he  was  a  Monotheist.     There  was  persecu- 


GALEN  99 

tion  of  the  Christians  in  his  day,  and  it  is  likely 
that  he  came  little  into  contact  with  the  disciples 
of  the  new  religion,  and  heard  distorted  accounts 
of  it,  but  in  one  of  his  lost  books,  quoted  by  his 
Arabian  biographers,  Galen  praises  highly  the  love 
of  virtue  of  the  Christians. 

He  no  doubt  found  the  practice  of  medicine 
lucrative  when  he  had  gained  pre-eminence,  and 
it  is  recorded  that  he  received  J6350  for  curing  the 
wife  of  Boetius,  the  Consul. 

Galen  wrote  no  less  than  five  hundred  treatises, 
large  and  small,  mostly  on  medical  subjects,  but 
also  on  ethics,  logic,  and  grammar.  His  style  is 
good  but  rather  diffuse,  and  he  delights  in  quoting 
the  ancient  Greek  philosophers.  Before  his  time, 
as  we  have  seen,  there  were  disputes  between  the 
various  medical  sects.  The  disciples  of  Dogmatism 
and  of  Empiricism  had  been  opposed  to  each  other 
for  several  centuries,  and  the  Eclectics,  Pneuma- 
tists,  and  Episynthetics  had  arisen  shortly  before 
his  time.  Galen  wrote  against  slavish  attach- 
naent  to  any  sect,  but  "  in  his  general  principles 
he  may  be  considered  as  belonging  to  the  Dogmatic 
sect,  for  his  method  was  to  reduce  all  his  know- 
ledge, as  acquired  by  the  observation  of  facts,  to 
general  theoretical  principles.  These  principles 
he,  indeed,  professed  to  deduce  from  experience  and 
observation,  and  we  have  abundant  proofs  of  his 
diligence  in  collecting  experience,  and  his  accuracy 
in  making  observations ;  but  still  in  a  certain  sense 


100  GEEEK  AND   ROMAN   MEDICINE 

at  least,  he  regards  individual  facts  and  the  details 
of  experience  as  of  little  value,  janconnected  with 
the  principles  whichi  he  had  laid  down  as  the  basis 
of  all  medical  reasoning.  In  this  fundamental 
point,  therefore,  the  method  pursued  by  Galen 
appears  to  have  been  directly  the  reverse  of  that 
which  we  now  consider  as  the  correct  method  of 
scientific  investigation ;  and  yet,  such  is  the  force 
of  natural  genius,  that  in  most  instances  he 
attained  the  ultimate  object  in  view,  although  by 
an  indirect  path.  He  was  an  admirer  of  Hippo- 
crates, and  always  speaks  of  him  with  the  most 
profound  respect,  professing  to  act  upon  his  prin- 
ciples, and  to  do  little  more  than  expound  his 
doctrines,  and  support  them  by  new  facts  and 
observations.  Yet,  in  reality,  we  have  few  writers 
whose  works,  both  as  to  substance  and  manner, 
are  more  different  from  each  other  than  those  of 
Hippocrates  and  Galen,  the  simplicity  of  the 
former  being  strongly  contrasted  with  the  abstruse- 
ness  and  refinement  of  the  latter,"^ 

A  list  of  the  various  editions  of  Galen's  works  is 
given  in  Dr.  Smith's  "  Dictionary  of  Greek  and 
Eoman  Biography  and  Mythology  "  (1890  edition, 
vol.  ii,  pp.  210-12),  and  also  the  titles  of  the 
treatises  classified  according  to  the  branch  of 
medical  science  with  which  they  deal,  and  it  is 
convenient  to  follow  this  classification. 

^  Dr.  Bostock's  "  History  of  Medicine." 


GALEN  101 

I. — WoEKS  ON  Anatomy  and  Physiology. 

Galen  insisted  upon  the  study  of  anatomy  as 
essential,  and  in  this  respect  was  in  conflict  with 
the  view  held  by  the  Methodists  and  the  Empirics 
who  believed  that  a  physician  could  understand 
diseases  without  any  knowledge  of  the  exact 
structure  of  the  body.  His  books  on  anatomy 
were  originally  fifteen  in  number.  The  last  six  of 
these  are  now  extant  only  in  an  Arabic  translation, 
two  copies  of  which  are  preserved  in  the  Bodleian 
Library  at  Oxford. 

The  directions  he  gives  for  dissection  show  that 
he  was  a  master  of  the  art.  In  dissecting  out  the 
portal  vein  and  its  ramifications,  for  instance,  he 
advises  that  a  probe  should  be  inserted  into  the 
vein,  and  the  point  of  the  probe  gradually  advanced 
as  the  surrounding  tissue  is  cut  away,  so  that 
finally  the  minute  branches  are  exposed;  and  he 
describes  the  use  of  the  blowpipe,  and  other  in- 
struments used  in  dissection.  He  carried  out  the 
experiment  of  tying  the  iliac  and  axillary  arteries 
in  animals,  and  found  that  this  procedure  stopped 
the  pulse  in  the  leg  and  arm,  but  caused  no  serious 
symptoms,  and  he  found  that  even  the  carotid 
arteries  could  be  tied  without  causing  death.  He 
also  pointed  out  that  tying  the  carotid  artery  did 
not  cause  loss  of  voice,  but  that  tying  the  artery 
carelessly  so  as  to  include  the  nerve  had  this  efiect. 
He  was  the  first  to  describe  the  ductus  arteriosus, 
and  the  three  coats  of  the  arteries. 


102  GREEK  AND   ROMAN   MEDICINE 

It  is  highly  improbable  that  Galen  dissected 
human  bodies  in  Rome,  though  he  dissected  a 
great  variety  of  the  lower  animals.  He  writes  that 
the  doctors  who  attended  Marcus  Aurelius  in  the 
German  wars  dissected  the  dead  bodies  of  the  bar- 
barians. The  chief  mistakes  made  by  Galen  as 
an  anatomist  were  due  to  his  assumption  that 
what  is  true  of  the  anatomy  of  a  lower  animal 
is  true  also  when  applied  to  man. 

Galen  greatly  assisted  the  advance  of  physiology 
by  recognizing  that  every  part  of  the  body  exists 
for  the  purpose  of  performing  a  definite  function. 
Aristotle,  like  Plato,  had  taught  that  "  Nature 
makes  nothing  in  vain,"  and  Galen's  philosophy 
was  greatly  influenced  by  the  teaching  of  Aristotle. 
Galen  regarded  his  work  as  ''  a  religious  hymn  in 
honour  of  the  Creator,  who  has  given  proof  of 
His  Omnipotence  in  creating  everything  perfectly 
conformable  to  its  destination." 

He  regarded  the  structure  of  various  parts, 
such  as  the  hand  and  the  membranes  of  the  brain, 
as  absolute  perfection,  although  his  idea  of  the 
human  hand  was  derived  from  a  study  of  the 
ape's,  and  he  had  no  knowledge  of  the  arachnoid 
membrane  of  the  brain,  but  it  would  be  unfair 
to  criticize  his  conclusions  because  of  his  failure 
to  recognize  a  few  comparatively  unimportant 
details.  He  discovered  the  function  of  the  motor 
nerves  by  cutting  them  experimentally,  and  so 
producing  paralysis  of  the  muscles;  the  platysma, 


GALEN  103 

interossei,  and  popliteus  muscles  were  first  described 
by  him.  He  was  the  greatest  authority  on  the 
pulse,  and  he  recognized  that  it  consisted  of  a 
diastole  (expansion)  and  a  systole  (contraction)  with 
an  interval  after  the  diastole,  and  another  after  the 
systole.  Aristotle  thought  that  arteries  contained 
air,  but  G-alen  taught  that  they  contained  blood, 
for,  when  an  artery  was  wounded,  blood  gushed 
out.  He  was  not  far  from  the  discovery  of  the 
circulation.  He  described  the  heart  as  having  the 
appearance  of  a  muscle,  and  considered  it  the  source 
of  natural  heat,  and  the  seat  of  violent  passions. 
He  knew  well  the  anatomy  of  the  human  skeleton, 
and  advised  students  to  go  to  Alexandria  where 
they  might  see  and  handle  and  properly  study  the 
bones.  He  recognized  that  inspiration  is  associated 
with  enlargement  of  the  chest,  and  imagined  that 
air  passed  inside  the  skull  through  the  cribriform 
plate  of  the  ethmoid  bone,  and  passed  out  by  the 
same  channel,  carrying  off  humours  from  the  brain 
into  the  nose.  But  some  of  this  air  remained  and 
combined  with  the  vital  spirits  in  the  anterior 
ventricles  of  the  brain,  and  finally  exuded  from  the 
fourth  ventricle,  the  residence  of  the  soul.  Aristotle 
had  taught  that  the  heart  was  the  seat  of  the  soul, 
and  the  brain  relatively  unimportant. 

II. — Works  on  Dietetics  and  Hygiene. 

Galen  was  a  strong  advocate   of  exercises   and 
gymnastics,  and  eulogizes  hunting  specially.     He 


104  GREEK  AND   EOMAN   MEDICINE 

recommends  cold  baths  for  people  in  the  prime  of 
life.  As  old  age  is  "  cold  and  dry,"  this  is  to  be 
treated  with  hot  baths  and  the  drinking  of  wine. 
He  thought  that  wine  was  particularly  suitable  for 
the  aged,  and  that  old  people  required  three  meals 
a  day,  others  two  meals.  He  had  a  very  high 
opinion  of  pork  as  an  article  of  diet,  and  said 
that  the  strength  of  athletes  could  not  be  main- 
tained without  this  form  of  food. 

III. — On  Pathology. 

Gralen  believed  in  the  doctrine  of  the  four 
elements,  and  his  speculations  led  him  into  a  belief 
in  a  further  subdivision.  "  Fire  is  hot  and  dry ; 
air  is  hot  and  moist ;  for  the  air  is  like  a  vapour ; 
water  is  cold  and  moist,  and  earth  is  cold  and  dry." 
He  held  that  there  were  three  principles  in  man — 
spirits,  solids,  and  humours — and  eight  tempera- 
ments ranging  between  health  and  disease  and 
compatible  with  life.  He  retained  a  good  deal  of 
the  teaching  of  the  Pneumatic  school,  and  believed 
that  the  pneuma  was  different  from  the  soul,  but 
the  vehicle  for  the  interaction  of  soul  and  body. 
From  his  theory  of  the  action  of  the  air  through  the 
nose  on  the  contents  of  the  ventricles  of  the  brain 
is  explained  his  use  of  sternutatories,  and  his  belief 
in  the  efl&cacy  of  sneezing.  Galen's  classification 
of  inflammations  shows  that  his  pathology  was 
not  nearly  so  accurate  as  his  anatomy  and 
physiology.     He  described  (a)  simple  inflammation 


GALEN  105 

caused  by  excess  of  blood  alone ;  (b)  inflammation 
the  result  of  excess  of  both  pneuma  and  blood; 
(c)  erysipelatous  inflammation  when  yellow  bile 
gains  admission,  and  (d)  scirrhous  or  cancerous 
when  phlegm  is  present.  He  did  good  service  by 
dividing  the  causes  of  disease  into  remote  and 
proximate,  the  former  subdivided  into  two  classes 
— predisposing  and  exciting. 

IV. — On  Diagnosis. 

He  relied  greatly  on  the  doctrine  of  "  critical 
days,"  which  were  thought  to  be  influenced  to  some 
extent  by  the  moon.  His  studies  of  the  pulse 
were  very  useful  to  him  in  diagnosis.  No  doubt, 
he  was  an  expert  diagnostician  mainly  owing  to  his 
long,  varied,  and  costly  medical  education,  and  his 
great  natural  powers  of  judgment.  He  asserted 
that  with  the  help  of  the  Deity  he  had  never  been 
wrong,  but  even  his  most  ardent  admirers  would 
not  be  wanting  in  enthusiasm  if  they  amended 
"never"  into  "hardly  ever." 

V. — On  Pharmacy,  Materia  Medica,  and 
Therapeutics. 

In  these  subjects  Galen  was  not  as  proficient  as 
Dioscorides,  whose  teaching  he  adopted  with  that 
of  other  medical  authors.  In  Galen's  works  there 
are  lengthy  lists  of  compound  medicines,  several 
medicines  being  recommended  for  the  same  disease, 


106  GREEK  AND   ROMAN   MEDICINE 

and  never  with  very  marked  confidence.  He  paid 
high  prices  for  various  nostrums,  and,  sad  to 
relate,  placed  great  faith  in  amulets,  belief  in  which 
was  general  in  his  time,  and  nowhere  held  more 
strongly  than  in  superstitious  Eome.  Medicines 
were  classified  by  him  according  to  their  qualities, 
by  which  he  meant,  not  their  therapeutic  effects, 
but  their  inherent  dryness  or  moistness,  coldness 
or  heat.  A  medicine  might  be  cold  in  the  first 
degree,  and  not  in  the  second  degree.  Paulus 
^gineta  followed  this  strange  and  foolish  doctrine 
of  Galen  very  closely,  as  the  following  extracts 
from  his  book  on  Materia  Medica  will  show: — 

"Cistus  (rock-rose). — It  is  an  astringent  shrub 
of  gently  cooling  powers.  Its  leaves  and  shoots 
are  so  desiccative  as  to  agglutinate  wounds  ;  but 
the  flowers  are  of  a  more  drying  nature,  being 
about  the  second  degree ;  and  hence,  when  drunk, 
they  cure  dysenteries  and  all  kinds  of  fluxes.''^ 

"Ferrum  (iron). — When  frequently  extinguished 
in  water,  it  imparts  a  considerable  desiccative 
power  to  it.  When  drunk,  therefore,  it  agrees  with 
affections  of  the  spleen."^ 

Many  features,  however,  of  Galen's  teaching  and 
practice  of  therapeutics  are  worthy  of  praise.  He 
enunciated  two  fundamental  principles  :  (1)  That 
disease  is  something  contrary  to  Nature,  and  is  to 

1  "  Paulus  iEgineta,"  vol.  iii,  p.  7i. 

2  Ibid.,  p.  242. 


GALEN  107 

be  overcome  by  that  which  is  contrary  "  to  the 
disease  itself " ;  and  (2)  that  Nature  is  to  be  pre- 
served by  what  has  relation  with  Nature.  He 
recognized  that  while  the  invading  disease  was  to 
be  repelled,  the  strength  and  constitution  of  the 
patient  should  be  preserved,  and  that  in  all  cases 
the  cause  of  the  disease  was  to  be  treated  and  not 
the  symptoms.  Strong  remedies  should  not  be 
used  on  weak  patients. 

VI. — Surgery. 

Galen  conformed  to  the  custom  of  the  physicians 
in  Eome,  and  did  not  practise  surgery  to  any 
extent,  although  he  used  the  lancet  in  phlebotomy, 
and  defended  this  practice  against  the  followers 
of  Erasistratus  in  Eome.  He  is  said  to  have 
resected  a  portion  of  the  sternum  for  caries,  and 
also  to  have  ligatured  the  temporal  artery.^ 

VII. — Gynecology. 

Galen  had  little  more  than  a  superficial  know- 
ledge of  this  subject,  and  was  quite  ignorant  of  the 
surgery  of  diseases  of  women.  He  was  not  so  well 
informed  as  Soranus  was  as  to  the  anatomy  of  the 
uterus  and  its  appendages,  but  deserves  credit  for 
having  been  better  acquainted  with  the  anatomy 
of    the    Fallopian   tubes    than    his    predecessors. 

^  "  Encycl.  Brit.,"  Surgery. 


]08  GEEEK  AND  ROMAN  MEDICINE 

He  had  erroneous  views  on  the  causation  of  dis- 
placements of  the  uterus.  Several  of  the  books 
inaccurately  attributed  to  the  authorship  of  Galen 
deal  with  the  medical  treatment  of  various  minor 
ailments  of  women. 

Galen  was  a  man  of  wide  culture,  and  one  of  his 
essays  is  written  for  the  purpose  of  urging  phy- 
sicians to  become  acquainted  with  other  branches 
of  knowledge  besides  medicine.  As  a  philosopher 
he  has  been  quoted  in  company  with  Plato  and 
Aristotle,  and  his  philosophical  writings  were 
greatly  used  by  Arabic  authors.  In  philosophy, 
as  in  medicine,  he  had  studied  the  teachings  of 
the  various  schools  of  thought,  and  did  not  bind 
himself  to  any  sect  in  particular.  He  disagreed 
with  the  Sceptics  in  their  belief  that  no  such  thing 
as  certainty  was  attainable,  and  it  was  his  custom 
in  cases  of  extreme  difficulty  to  suspend  his  judg- 
ment ;  for  instance,  in  reference  to  the  nature  of 
the  soul,  he  wrote  that  he  had  not  been  able  to 
come  to  a  definite  opinion. 

Galen  mentions  the  discreditable  conduct  of 
physicians  at  consultations.  Sometimes  several 
doctors  would  hold  a  consultation,  and,  appar- 
ently forgetting  the  patient  for  the  time,  would 
hold  violent  disputations.  Their  main  object  was 
to  display  their  dialectical  skill,  and  their  argu- 
ments sometimes  led  to  blows.  These  discredit- 
able exhibitions  were  rather  frequent  in  Eome  in 
his  time. 


GALEN  109 

With  Galen,  as  with  Hippocrates,  it  is  some- 
times impossible  to  tell  what  works  are  genuine, 
and  what  are  spurious.  He  seemed  to  think  that 
he  was  the  successor  of  Hippocrates,  and  wrote : 
"  No  one  before  me  has  given  the  true  method  of 
treating  disease :  Hippocrates,  I  confess,  has  here- 
tofore shown  the  path,  but  as  he  was  the  first  to 
enter  it,  he  was  not  able  to  go  as  far  as  he  wished. 
.  .  .  He  has  not  made  all  the  necessary  dis- 
tinctions, and  is  often  obscure,  as  is  usually  the 
case  with  ancients  when  they  attempt  to  be  con- 
cise. He  says  very  little  of  complicated  diseases  ; 
in  a  word,  he  has  only  sketched  what  another  was 
to  complete ;  he  has  opened  the  path,  but  has  left 
it  for  a  successor  to  enlarge  and  make  it  plain." 
Galen  strictly  followed  Hippocrates  in  the  latter's 
humoral  theory  of  pathology,  and  also  in  thera- 
peutics to  a  great  extent. 

It  is  a  speculation  of  much  interest  how  it  was 
that  Galen's  views  on  Medicine  received  universal 
acceptance,  and  made  him  the  dictator  in  this 
realm  of  knowledge  for  ages  after  his  death.  He 
was  not  precisely  a  genius,  though  a  very  remark- 
able man,  and  he  established  no  sect  of  his  own. 
The  reason  of  his  power  lay  in  the  fact  that  his 
writings  supplied  an  encyclopaedic  knowledge  of 
the  medical  art  down  to  his  own  time,  with  com- 
mentaries and  additions  of  his  own,  written  with 
great  assurance  and  conveying  an  impression  of 
finality,  for  he  asserted  that  he  had  finished  what 


110  GREEK  AND   EOMAN   MEDICINE 

Hippocrates  had  begun.  The  world  was  tired  of 
political  and  philosophical  strife,  and  waiting  for 
authority.  The  wars  of  Eome  had  resulted  in 
placing  political  power  in  the  hands  of  one  man, 
the  Emperor;  the  disputations  and  bickerings  of 
philosophers  and  physicians  produced  a  similar 
result,  and  Galen,  in  the  medical  world  was  in- 
vested with  the  purple. 

The  efiect,  therefore,  of  Galen's  writings  was,  at 
first,  to  add  to  and  consolidate  medical  knowledge, 
but  his  influence  soon  became  an  obstacle  to  pro- 
gress. Even  in  the  sixteenth  and  seventeenth 
centuries,  Galenism  held  almost  undisputed  sway. 

The  house  of  Galen  stood  opposite  the  Temple 
of  Romulus  in  the  Eoman  Forum.  This  temple, 
in  A.D.  530,  was  consecrated  by  Pope  Felix  lY 
to  the  honour  of  the  saints,  Cosma  and  Damiano, 
two  Arabian  anargyri  (unpaid  physicians)  who 
suffered  martyrdom  under  Diocletian. 

The  date  of  Galen's  death  is  not  exactly  known, 
but  was  probably  a.d.  200. 


Ill 


CHAPTEE  X. 

THE   LATER  EOMAN   AND  BYZANTINE  PEEIOD. 

Beginning  of  Decline — Neoplatonism — Antyllus  — Oribasius — 
Magnus — Jacobus  Psychristus — Adamantius — Melefcius — 
Nemesius — JEtius — Alexander  of  Tralles — The  Plague — 
Moschion — Paulus  ^gineta — Decline  of  Healing  Art. 

The  death  of  Galen  marks  the  beginning  of 
the  decline  of  medical  science  in  ancient  times, 
and  this  decline  was  contemporaneous  with  the 
overthrow  of  the  Roman  State.  As  everybody 
knows,  the  decline  and  fall  of  the  Roman  Empire 
resulted  from  the  profligacy  and  incapacity  of  the 
emperors,  luxurious  living  and  vice  among  the 
people,  tyranny  of  an  overbearing  soldiery  at 
home,  and  the  attacks  of  barbarian  foes  gradu- 
ally increasing  in  strength.  Rome  fell  quickly 
into  the  hands  of  the  barbarians,  and  her  power 
was  broken.  In  a.d.  395,  was  founded  the 
Byzantine  Empire,  also  styled  the  East  Roman, 
Greek,  or  Lower  Empire,  which  lasted  for  more 
than  a  thousand  years,  and  took  its  name  from  the 
capital,  Byzantium  or  Constantinople.  In  this 
empire  medical  science  maintained  a  feeble  and 
sickly  existence.  During  this  Byzantine  Period 
there  were  a  few  physicians  of  note,  but  they 
were  mainly  commentators,  and  medical  science 
retrograded  rather  than  progressed. 


iii2 


GEEEK  AND   EOMAN   MEDICINE 


Neoplatonism  exerted  a  powerful  influence  upon 
the  healing  art.  It  was  founded  by  Plotinus,  and 
was  for  three  centuries  a  formidable  rival  to 
Christianity.  The  Neoplatonists  believed  that 
man  could  intuitively  know  the  absolute  by  a 
faculty  called  Ecstasy.  Neoplatonism  is  a  term 
which  covers  a  very  wide  range  of  varying  thought ; 
essentially,  it  was  a  combination  of  philosophy 
and  religion,  arising  from  the  intellectual  move- 
ment in  Alexandria.  It  covered  a  great  deal  of 
mysticism,  magic  and  spiritualism,  and  the  followers 
of  the  system,  as  it  developed,  became  believers 
in  the  efficacy  of  certain  exercises  and  symbols 
to  cure  diseases.  They  entered  as  Kingsley 
wrote,  "  the  fairy  land  of  ecstasy,  clairvoyance, 
insensibility  to  pain,  cures  produced  by  the  effect 
of  what  we  now  call  mesmerism.  They  are  all 
there,  these  modern  puzzles,  in  those  old  books 
of  the  long  bygone  seekers  for  wisdom."  It  is 
wonderful  how  mankind  in  their  pursuit  of 
knowledge  seem  to  have  progressed  in  a  circle. 

The  influence  which  Christianity  exerted  upon 
the  investigation  of  medical  science  during  the 
early  centuries  of  our  era  will  be  considered  at 
length  in  a  subsequent  chapter. 

Antyllus  was  perhaps  the  greatest  surgeon  of 
antiquity.  He  lived  before  the  end  of  the  fourth 
century  a.d.,  for  he  is  quoted  by  Oribasius,  but  is  not 
mentioned  by  Galen.  The  time  in  which  he  lived 
was  about  the  year  a.d.  300.    He  was  a  voluminous 


THE  LATER  ROMAN  AND  BYZANTINE  PERIOD    113 

writer,  but  his  works  have  perished  except  for 
quotations  by  later  writers.  The  fragments  of  his 
writings  were  collected  and  published  in  1799. 
Antyllus  performed  an  operation  for  aneurism, 
which  consisted  in  laying  open  the  sac,  turning 
out  the  clots,  securing  the  vessels  above  and  below, 
and  allowing  the  wound  to  heal  by  granulation. 
As  this  operation  was  performed  without  anaes- 
thetics or  antiseptics  it  was  attended  with  great 
mortality,  and  the  risk  of  secondary  haemorrhage 
was  very  great.  Antyllus  had  operations  for  the 
cure  of  stammering,  for  cataract,  and  for  the  treat- 
ment of  contractures  by  the  method  of  tenotomy. 
He  also  removed  enlarged  glands  of  the  neck.  It 
was  part  of  the  practice  of  Antyllus  to  ligature 
arteries  before  cutting  them,  a  method  which  was 
subsequently  "rediscovered"  owing  to  neglect  of 
the  study  of  the  history  of  medicine.  He  gave 
directions  for  avoiding  the  carotid  artery  and 
internal  jugular  vein  in  operations  upon  the  neck. 

A  fragment  of  the  writings  of  Antyllus  is  pre- 
served by  Paulus  ^gineta,^  and  shows  the  quality 
of  the  work  done  in  bygone  ages.  It  is  his 
description  of  the  operation  of  tracheotomy,  and 
runs  as  follows  : — 

"  When  we  proceed  to  perform  this  operation 
we  must  cut  through  some  part  of  the  windpipe, 
below  the  larynx,  about  the  third  or  fourth  ring ; 

'  "  De  re  Med.,"  vi,  33. 


114  GREEK  AND   ROMAN   MEDICINE 

for  to  divide  the  whole  would  be  dangerous.  This 
place  is  commodious,  because  it  is  not  covered 
with  any  flesh,  and  because  it  has  no  vessels 
situated  near  the  divided  part.  Therefore,  bending 
the  head  of  the  patient  backward,  so  that  the 
windpipe  may  come  more  forward  to  the  view,  we 
make  a  transverse  section  between  two  of  the  rings, 
so  that  in  this  case  not  the  cartilage  but  the 
membrane  which  unites  the  cartilages  together, 
is  divided.  If  the  operator  be  a  little  timid,  he 
may  first  stretch  the  skin  with  a  hook  and  divide 
it ;  then,  proceeding  to  the  windpipe,  and  separat- 
ing the  vessels,  if  any  are  in  the  way,  he  may 
make  the  incision."  This  operation  had  been 
proposed  by  Asclepiades  about  three  hundred  years 
before  the  time  of  Antyllus. 

Oribasius  was  born  at  Pergamos,  the  birthplace 
of  Galen,  about  a.d.  326.  He  studied  under  Zenon, 
who  lectured  and  practised  at  Alexandria,  and  was 
expelled  by  the  bishop,  but  afterwards  reinstated 
by  command  of  the  Emperor  Julian  (a.d.  361). 
When  Julian  was  kept  in  confinement  in  Asia 
Minor,  Oribasius  became  acquainted  with  him,  and 
they  were  soon  close  friends.  When  Julian  was 
raised  to  the  rank  of  Caesar,  Oribasius  accompanied 
him  into  Gaul.  During  this  journey  Oribasius,  at 
the  request  of  his  patron,  made  an  epitome  of  the 
writings  of  Galen,  and  then  extended  the  work  by 
including  a  collection  of  the  writings  of  all  preced- 
ing medical  authors.     When  this  work  was  finally 


THE   LATER  ROMAN   AND   BYZANTINE   PERIOD        115 

completed  it  consisted  of  seventy  books  under  the 
title  "  Collecta  Medicinalia."  He  wrote  also  for 
his  friend  and  biographer  Eunapius  two  books 
on  diseases  and  their  treatment,  and  treatises  on 
anatomy  and  on  the  works  of  Galen.  He  earned  for 
himself  the  title  of  the  Ape  of  Galen.  In  the  "  Life 
of  Oribasius,"  by  Eunapius,  we  find  that  Julian 
created  Oribasius  Quaestor  of  Constantinople,  but 
after  the  death  of  Julian,  Oribasius  was  exiled, 
and  practised  among  the  "  barbarians,"  attaining 
great  fame.  In  his  exile  he  married  a  rich  woman 
of  good  family,  and  to  one  of  his  sons,  Eustathius 
by  name,  he  addressed  an  abridgment  of  his  first 
great  book,  the  smaller  work  being  called  the 
"  Synopsis."  He  ultimately  returned  from  exile, 
and  again  reached  a  very  honourable  position,  to 
which  he  was  well  entitled  in  virtue  of  the  great 
fortitude  with  which  he  had  borne  adversity. 

An  edition  of  Oribasius  was  published  at  Paris 
between  1851  and  1876,  in  six  volumes,  by  Darem- 
berg  and  Bussemaker,  under  the  patronage  of  the 
Erench  Government.  The  authors  of  this  edition 
took  infinite  pains  to  show  the  sources  from  which 
the  writings  of  Oribasius  had  been  derived,  chief 
of  which  were  the  original  writings  of  Galen, 
Hippocrates,  Soranus,  Rufus,  and  Antyllus.  Oriba- 
sius was  almost  entirely  a  compiler,  but  also  did 
some  original  work.  To  him  is  due  the  credit  of 
describing  the  drum  of  the  ear  and  the  salivary 
glands.      He    described   also   the    strange  disease 


116  GREEK  AND   EOMAN   MEDICINE 

called  lycanthropy,  a  form  of  insanity  in  which 
the  patient  thinks  himself  a  wolf,  and  leaves  his 
home  at  night  to  wander  amongst  the  tombs. 

Oribasius  was  held  to  be  the  wisest  man  of  his 
time.  There  was  something  very  charming  in  his 
manner  and  conversation,  and  the  barbarians  con- 
sidered him  as  little  less  than  a  god. 

Magnus,  a  native  of  Mesopotamia,  was  a  pupil 
of  Zenon  and  lectured  at  Alexandria.  He  was 
famous  for  his  eloquence  and  dialectical  skill;  and 
wrote  a  book  on  "  Urine  "  which  is  referred  to  by 
Theophilus. 

Jacobus  Fsychristus  was  a  famous  physician  who 
practised  at  Constantinople,  a.d.  451-414.  He 
was  called  "the  Saviour"  because  of  the  great 
success  of  his  treatment. 

Adamantius  of  Alexandria  both  taught  and 
practised  medicine.  He  was  a  Jewish  physician 
who  was  expelled  from  Alexandria  in  a.d.  415,  and 
settled  in  Constantinople. 

Meletius  was  a  Christian  monk  who  lived  in  the 
fourth  century,  according  to  some  authorities,  but 
it  is  probable  that  he  belonged  to  a  later  period, 
the  sixth  or  seventh  century.  He  wrote  on  the 
nature  of  man,  but  the  book  is  of  no  value  as  a 
contribution  to  physiology. 

Nemesius,  Bishop  of  Emissa,  at  the  end  of  the 
fourth  century  wrote  a  book  called  "  De  Natura 
Hominis,"  and  came  very  close  to  two  important 
discoveries,  namely,  the  functions  of  the  bile  and 


THE   LATER  ROMAN  AND  BYZANTINE   PERIOD         117 

the  circulation  of  the  blood.  Of  the  former,  he 
wrote,  "  The  yellow  bile  is  constituted  both  for 
itself  and  for  other  purposes ;  for  it  contributes  to 
digestion  and  promotes  the  expulsion  of  the  excre- 
ments ;  and  therefore  it  is  in  a  manner  one  of  the 
nutritive  organs,  besides  imparting  a  sort  of  heat 
to  the  body,  like  the  vital  power.  For  these 
reasons,  therefore,  it  seems  to  be  made  for  itself; 
but,  inasmuch  as  it  purges  the  blood,  it  seems  to 
be  made  in  a  manner  for  this  also."  ^ 

With  reference  to  the  circulation  of  the  blood, 
Nemesius  wrote  :  "  The  motion  of  the  pulse  (called 
also  the  vital  power)  takes  its  rise  from  the  heart 
and  chiefly  from  its  left  ventricle.  The  artery  is 
with  great  vehemence  dilated  and  contracted,  by  a 
sort  of  constant  harmony  and  order,  the  motion 
commencing  at  the  heart.  While  it  is  dilated  it 
draws  with  force  the  thinner  part  of  the  blood 
from  the  neighbouring  veins,  the  exhalation  or 
vapour  of  which  blood  becomes  the  aliment  for  the 
vital  spirit.  But  while  it  is  contracted  it  exhales 
whatever  fumes  it  has  through  the  whole  body  and 
by  secret  passages,  as  the  heart  throws  out  what- 
ever is  fuliginous  through  the  mouth  and  nose  by 
expiration."  ^ 

This  book  was  first  translated  into  English 
in  1636. 


1  C.  28,  p.  260,  ed.  Matth. 

2  C.  24,  p.  242. 


118  GREEK  AND  EOMAN  MEDICINE 

Nemesius  also  wrote  on  religion  and  philosophy. 
In  regard  to  his  medical  writings,  although  he  did 
not  go  far  enough  to  anticipate  the  discovery  of 
Harvey,  his  contribution  to  medical  science  was 
remarkable. 

stills  was  born  in  Mesopotamia  and  lived  at  the 
end  of  the  fifth  or  the  beginning  of  the  sixth 
century.  He  studied  at  Alexandria,  and  settled 
at  Constantinople,  where  he  attained  to  the 
honour  of  court  chamberlain,  and  physician  to 
the  Emperor  Justinian.  He  was  the  first  notable 
physician  to  profess  Christianity.  In  compound- 
ing medicines,  he  recommended  that  the  following 
prayer  should  be  repeated  in  a  low  voice :  "  May 
the  God  of  Abraham,  the  God  of  Isaac,  and 
the  God  of  Jacob  deign  to  bestow  upon  this 
medicament  such  and  such  virtues."  To  extract 
a  piece  of  bone  sticking  in  the  throat,  the  physician 
should  call  out  loudly :  "As  Jesus  Christ  drew 
Lazarus  from  the  grave,  and  as  Jonah  came  out  of 
the  whale,  thus  Blasius,  the  martyr  and  servant 
of  God,  commands,  '  Bone,  come  up  or  go  down.'  " 

^tius  wrote  the  "  Sixteen  Books  on  Medicine," 
and  these  contain  original  matter,  but  are  of  value 
mainly  as  being  a  compilation  of  the  medical 
knowledge  of  his  time.  He  was  the  first  writer 
to  mention  certain  Eastern  drugs,  such  as  cloves 
and  camphor,  and  had  a  great  knowledge  of  the 
spells  and  charms  used  in  the  East,  more  especially 
by  the  Egyptian  Christians.      All   the   nostrums, 


THE   LATER  KOMAN   AND  BYZANTINE   PEEIOD        119 

amulets  and  charms  that  were  used  at  the  time 
are  enumerated,  and  display  a  gloomy  picture  of 
the  superstition  and  ignorance  that  prevailed. 
The  surgical  and  gynaecological  sections  of  the 
writings  of  ^tius  are,  in  most  parts,  excellent. 
He  treated  cut  arteries  by  twisting  or  tying, 
and  advised  the  irrigation  of  wounds  with  cold 
water.  In  the  operation  of  lithotomy  he  recom- 
mended that  the  blade  of  the  knife  should  be 
guarded  by  a  tube.  He  used  the  seton  and  the 
cautery,  which  was  much  in  vogue  in  his  day,  espe- 
cially in  cases  of  paralysis.  He  quotes  Archigenes, 
who  wrote :  "  I  should  not  at  all  hesitate  to  make 
an  eschar  in  the  nape  of  the  neck,  where  the  spinal 
marrow  takes  its  rise,  two  on  each  side  of  it  .  .  . 
and  if  the  ulcers  continue  running  a  good  while,  I 
should  not  doubt  of  a  perfect  recovery." 

Alexander  of  Tralles  lived  from  a.d.  525  to  605. 
He  was  the  son  of  a  physician,  and  one  of  five 
brothers,  who  were  all  distinguished  for  scholarship. 
He  studied  philosophy  as  well  as  medicine,  and 
travelled  in  France,  Spain,  and  Italy  to  extend 
his  knowledge.  He  took  up  permanent  residence 
in  Rome,  and  became  very  celebrated.  When 
he  became  too  old  to  continue  active  practice,  he 
found  leisure  to  write  twelve  books  on  medical 
diseases,  following  to  some  extent  the  teaching 
of  Galen.  The  style  of  these  books  is  elegant,  and 
his  description  of  diseases  accurate.  Alexander  of 
Tralles   was  the  first  to  open  the  jugular  vein  in 


120  GREEK  AND   ROMAN   MEDICINE 

disease,  and  employed  iron  and  other  useful 
remedies,  but  he  lived  in  superstitious  times,  and 
was  very  credulous.  For  epilepsy,  he  recommended 
a  piece  of  sail  from  a  wrecked  vessel,  worn  round 
the  arm  for  seven  weeks. ^  For  colic,  he  recom- 
mended the  heart  of  a  lark  attached  to  the  right 
thigh,  and  for  pain  in  the  kidneys  an  amulet 
depicting  Hercules  overcoming  a  lion.  To  exorcise 
gout,  he  used  incantations,  these  being  either 
oral  or  written  on  a  thin  sheet  of  gold  during 
the  waning  of  the  moon.  Writing  a  suitable 
inscription  on  an  olive  leaf,  gathered  before  sunrise, 
was  his  specific  for  ague.  Alexander  appears  at 
times  to  have  doubted  the  efficacy  of  such  remedies 
as  amulets,  for  he  explains  that  his  rich  patients 
would  not  submit  to  rational  treatment,  and  it  was 
necessary,  therefore,  to  use  other  methods  reputed 
to  be  curative. 

In  the  age  of  Justinian  great  scourges  devastated 
the  world.  In  a.d.  526  Antioch  was  destroyed  by 
an  earthquake,  and  it  is  said  that  250,000  people 
perished,  but  the  most  dreadful  visitation  on  man- 
kind was  the  great  plague  which  raged  in  a.d.  542 
and  the  following  years,  and,  as  Gibbon  writes, 
"  depopulated  the  earth  in  the  time  of  Justinian 
and  his  successors."  Procopius,  who  was  versed  in 
medicine,  was  the  historian  of  the  period.  This 
fell  disease  began  between  the  Serbonian  bog  and 

^  Lib.  1,  c.  20. 


THE  LATEE  ROMAN  AND  BYZANTINE  PERIOD    121 

the  eastern  channel  of  the  Nile.  "  From  thence, 
tracing  as  it  were  a  double  path,  it  spread  to  the 
east,  over  Syria,  Persia,  and  the  Indies,  and  pene- 
trated to  the  west,  along  the  coast  of  Africa,  and 
over  the  continent  of  Europe.  In  the  spring  of  the 
second  year,  Constantinople,  during  three  or  four 
months,  was  visited  by  the  pestilence ;  and  Proco- 
pius,  who  observed  its  progress  and  symptoms  with 
the  eyes  of  a  physician,  has  emulated  the  skill  and 
diligence  of  Thucydides  in  the  latter's  description  of 
the  plague  of  Athens.  The  infection  was  sometimes 
announced  by  the  visions  of  a  distempered  fancy, 
and  the  victim  despaired  as  soon  as  he  had  heard 
the  menace  and  felt  the  stroke  of  an  invisible 
spectre.  But  the  greater  number,  in  their  beds,  in 
the  streets,  in  their  usual  occupation,  were  sur- 
prised by  a  slight  fever,  so  slight,  indeed,  that 
neither  the  pulse  nor  the  colour  of  the  patient  gave 
any  signs  of  the  approaching  danger.  The  same, 
the  next,  or  the  succeeding  day,  it  was  declared  by 
the  swelling  of  the  glands,  particularly  those  of  the 
groin,  of  the  armpits,  and  under  the  ear ;  and 
when  these  buboes  or  tumours  were  opened  they 
were  found  to  contain  a  coal,  or  black  substance,  of 
the  size  of  a  lentil.  If  they  came  to  a  first  swell- 
ing and  suppuration,  the  patient  was  saved  by  this 
kind  and  natural  discharge  of  the  morbid  humour. 
But  if  they  continued  hard  and  dry,  a  mortification 
quickly  ensued,  and  the  fifth  day  was  commonly  the 
term  of  his  life.     The  fever  was  often  accompanied 


122  GREEK   AND   ROMAN   MEDICINE 

with  lethargy  or  delirium;  the  bodies  of  the  sick 
were  covered  with  black  pustules  or  carbuncles, 
the  symptoms  of  immediate  death ;  and  in  the 
constitutions  too  feeble  to  produce  an  eruption,  the 
vomiting  of  blood  was  followed  by  a  mortification 
of  the  bowels.  To  pregnant  women  the  plague 
was  generally  mortal;  yet  one  infant  was  drawn 
alive  from  its  dead  mother,  and  three  mothers 
survived  the  loss  of  their  infected  foetus.  Youth 
was  the  most  perilous  season  :  and  the  female  sex 
was  less  susceptible  than  the  male  ;  but  every  rank 
and  profession  was  attacked  with  indiscriminate 
rage,  and  many  of  those  who  escaped  were 
deprived  of  their  speech,  without  being  secure  from 
a  return  of  the  disorder.  The  physicians  of 
Constantinople  were  zealous  and  skilful,  but  their 
art  was  baffled  by  the  various  symptoms  and 
pertinacious  vehemence  of  the  disease ;  the  same 
remedies  were  productive  of  contrary  effects  and 
the  event  capriciously  disappointed  their  prognos- 
tics of  death  or  recovery.  The  order  of  funerals 
and  the  right  of  sepulchres  were  confounded ; 
those  who  were  left  without  friends  or  servants 
lay  unburied  in  the  streets,  or  in  their  desolate 
houses ;  and  a  magistrate  was  authorized  to  collect 
the  promiscuous  heaps  of  dead  bodies,  to  transport 
them  by  land  or  water,  and  to  inter  them  in  deep 
pits  beyond  the  precincts  of  the  city.  .  .  No 
facts  have  been  preserved  to  sustain  an  account,  or 
even  a  conjecture,  of  the  number  that  perished  in 


THE   LATER   ROMAN   AND   BYZANTINE   PERIOD         123 

this  extraordinary  mortality.  I  only  find,  that 
during  three  months  5,000,  and  at  length  10,000, 
persons  died  each  day  at  Constantinople;  that 
many  cities  of  the  East  were  left  vacant,  and  that 
in  several  districts  of  Italy  the  harvest  and  the 
vintage  withered  on  the  ground.'" 

The  spread  of  disease  from  East  to  West  was 
again  exemplified  in  the  Middle  Ages,  in  the  time 
of  the  Crusades,  when  the  Crusaders  carried  home 
diseases  to  their  native  lands.  The  Knights  of 
St.  John,  it  is  interesting  to  observe,  superin- 
tended hospitals  at  home,  and  wore  the  white 
dress  which  in  earlier  times  had  distinguished  the 
Asclepiades. 

Moschion  probably  lived  in  the  sixth  century, 
and  was  a  specialist  in  diseases  of  women.  His 
writings  were  studied  when  Soranus  was  forgotten, 
but  in  course  of  time  it  was  discovered  that 
Moschion's  work  was  nothing  but  an  abbreviated 
translation  of  the  works  of  Soranus.  "Further, 
it  is  held  by  Weber  and  Ermerins  that  even  the 
original  Moschion  is  not  based  directly  on  Soranus, 
but  on  a  work  on  diseases  of  women  written  in  the 
fourth  century  by  Cselius  Aurelianus,  who  in  his 
turn  drew  from  Soranus.  .  .  It  is  interesting 
to  follow  the  history  of  this  book  through  its 
various  stages  in  the  light  of  these  different 
editions,  and  we  would  suggest  that  the  first  Latin 

^  Gibbon,  "  The  Decline  and  Fall  of  the  Eoman  Empire." 


124  GREEK  AND   EOMAN   MEDICINE 

version,  for  the  use  of  Latin-speaking  matrons 
and  midwives,  was  produced  before  the  fall  of 
the  Western  Empire  in  the  fifth  century ;  its 
Greek  sister  just  fits  in  with  the  develop- 
ment of  Eastern  or  Greek-speaking  Empire  at 
Constantinople  in  the  sixth  century;  and  the 
version  in  barbarous  Latin  points  to  a  later  period, 
when  learning  was  beginning  to  make  way  again  in 
Western  Europe."^  Moschion's  book  is  a  catechism 
consisting  of  152  questions  and  answers. 

Paulus  jEgmeta  was  the  last,  and  one  of  the 
most  famous,  of  the  Greek  physicians.  He  was 
born  probably  in  the  seventh  century  in  the  island 
of  ^gina,  but  there  is  some  doubt  as  to  the  exact 
period  in  which  he  lived.  He  quotes  Alexander 
of  Tralles  and  yEtius,  and  therefore  lived  at  a  later 
period  than  they  did,  either  in  the  sixth  or  seventh 
century.  The  works  of  Paulus  are  compilations, 
but  reveal  the  skill  and  learning  of  the  author. 
He  wrote  several  books,  but  only  one,  and  that  the 
principal,  remains,  and  is  known  by  the  title  of 
"  De  Ee  Medica  Libri  Septem."  Dr.  Adams,  of 
Banchory,  translated  this  book  for  the  Sydenham 
Society,  and  the  introduction  shows  the  scope  of 
the  work :  "In  the  first  book  you  will  find 
everything  that  relates  to  hygiene,  and  to  the 
preservation  from,  and  correction  of,  distempers 
peculiar   to    the   various    ages,   reasons,    tempera- 

^  Barbour,  Edinburgh  Medical  Journal,  vol.  xxxiv,  p.  331. 


THE   LATER    ROMAN   AND   BYZANTINE   PERIOD        125 

ments,  and  so  forth ;  also  the  powers  and  use  of 
the  different  articles  of  food,  as  is  set  forth  in  the 
chapter  of  contents.  In  the  second  is  explained 
the  whole  doctrine  of  fevers,  an  account  of  certain 
matters  relating  to  them  being  premised,  such  as 
excrementitious  discharges,  critical  days,  and  other 
appearances,  and  concluding  with  certain  symptoms 
which  are  the  concomitants  of  fevers.  The  third 
book  relates  to  topical  affections,  beginning  from 
the  crown  of  the  head  and  descending  down  to  the 
nails  of  the  feet,"  and  so  on.  Briefly,  the  fourth 
book  treats  of  external  diseases ;  the  fifth,  of  wounds 
and  bites  from  venomous  animals ;  the  sixth  book 
is  the  most  important  and  is  devoted  to  surgery, 
and  contains  original  observations,  and  the  seventh 
book  contains  an  account  of  the  properties  of 
medicines."  Paulus  wrote  a  famous  book  on 
obstetrics,  which  is  now  lost,  but  it  gained  for  him 
among  the  Arabs  the  title  of  "the  accoucheur." 

The  sixth  book  on  surgery,  as  has  justly  been 
observed  by  Adams,  "  contains  the  most  complete 
system  of  operative  surgery  which  has  come  down 
to  us  from  ancient  times."  Many  important 
surgical  principles  are  enunciated,  such,  for  in- 
stance, as  local  depletion  as  against  general,  and 
the  merit  of  a  free  external  incision.  He  first 
described  varicose  aneurism,  and  performed  the 
operation  of  bronchotomy  as  described  by  Antyllus. 
He  favoured  the  lateral  operation  for  removal 
of   stone   from   the   bladder,   and  amputated  the 


126  GEEEK  AND   ROMAN   MEDICINE 

cancerous  breast  by  crucial  incision.  He  also  bad 
an  operation,  like  tbat  of  Antyllus,  for  tbe  cure  of 
aneurism.  In  brief,  Paulus  performed  many  of  tbe 
operations  tbat  are  practised  at  tbe  present  day. 
He  travelled  in  the  practice  of  bis  calling,  and  not 
only  bad  great  fame  in  tbe  Byzantine  Empire  and 
in  Arabia  in  bis  lifetime,  but  exercised  great 
influence  for  some  centuries.  His  writings  inspired 
Albucassis,  one  of  tbe  few  surgeons  and  teacbers 
of  tbe  Middle  Ages. 

After  tbe  time  of  Paulus  ^gineta  tbe  practice 
of  medicine  and  surgery  suffered  a  very  rapid 
decline,  and  for  five  centuries  no  progress  was 
made.  Tbe  Middle  Ages  form  a  dark  and  melan- 
choly period  in  tbe  history  of  medicine,  and  we 
have  to  come  to  comparatively  recent  times  before 
we  find  tbe  skill  and  knowledge  of  tbe  Ancients 
equalled,  while  it  is  only  at  tbe  present  day  tbat 
they  are  rapidly  being  excelled. 


127 


CHAPTEE  XI. 

INFLUENCE  OF  CHEISTIANITY  ON  ALTEUISM  AND 
THE  HEALING  AET. 

Essenes — Cabalists  and  Gnostics — Object  of  Christ's  Mission 
— Stoics — Constantine  and  Justinian — Gladiatorial  Games 
— Orphanages — Support  of  the  Poor — Hospitals — Their 
Foundation  —  Christianity  and  Hospitals  —  Fabiola  — 
Christian  Philanthropy  —  Demon  Theories  of  Disease 
receive  the  Church's  Sanction — Monastic  Medicine — 
Miracles  of  Healing  —  St.  Paul — St.  Luke  —  Proclus  — 
Practice  of  Anatomy  denounced — Christianity  the  prime 
factor  in  promoting  Altruism. 

The  sect  of  the  Essenes  embraced  part  of  the 
teaching  of  Christianity  among  their  other  beHefs. 
They  conceived  that  the  Almighty  had  to  be 
propitiated  by  signs  and  symbols.  Words,  they 
considered,  were  the  direct  gift  of  God  to  man, 
and,  therefore,  signs  representing  words  were  of 
great  avail.  Hence  arose  the  use  of  amulets  and 
cabalistic  signs,  or,  rather,  the  common  use,  for 
they  had  been  in  evidence  long  prior  to  the 
foundation  of  this  sect.  Amulets  were  worn  on 
the  person.  The  Jews  had  phylacteries  or  bits 
of  parchment  on  which  were  written  passages 
from  the  Scriptures.  In  the  first  century  after 
Christ,  Jews,  Pythagoreans,  Essenes,  and  various 
sects     of     mystics    combined    and    formed     the 


128  GREEK  AND   ROMAN   MEDICINE 

Cabalists  and  Gnostics.  Their  creed  embraced  the 
magic  01  the  Persians,  the  dreams  of  the  Ascle- 
piads,  the  numbers  of  Pythagoras,  and  the  theory 
of  atoms  of  Democritus.  The  Sophists  of 
Alexandria  actually  regarded  magic  as  a  science. 
A  section  of  the  early  Christians  were  Gnostics? 
and  were  imbued  with  the  philosophy  of  the 
Orientals.  According  to  the  beliefs  of  the  Cabalists 
and  Grnostics,  demons  were  the  cause  of  disease. 
These  sects  interrogated  evil  spirits  to  find  out 
where  they  lurked,  and  exorcised  them  with  the 
help  of  charms  and  talismans.  Various  geometric 
figm-es  and  devices  were  held  to  have  power  against 
evil  spirits.  One  of  these  figures  was  the  device  of 
two  triangles  interlaced  thus  ^.  This  was  used 
as  a  symbol  of  God,  not  only  by  Cabalists  and 
Gnostics,  but  also  by  Jews.  The  great  majority 
of  the  early  Christians  opposed  the  Gnostics,  and 
repudiated  and  abhorred  their  strange  mixture  of 
the  Christian  religion  with  Eastern  philosophy. 

Christ  came  into  the  world  at  a  time  when  the 
evils  of  slavery  were  probably  at  their  worst.  He 
did  not  direct^  condemn  slavery,  and  the  reason 
of  this  is  to  be  found  in  the  study  of  the  nature  of 
His  mission.  He  came  to  regenerate  the  individual, 
and  not,  primarily,  society,  "  His  language  in 
innumerable  similes  showed  that  he  believed  that 
those  principles  He  taught  would  only  be  success- 
ful after  long  periods  of  time  and  gradual  develop- 
ment.    Most  of  His  figures  and  analogies  in  regard 


INFLUENCE   OF   CHEISTIANITY   ON   ALTKUISM         129 

to  '  the  Kingdom  of  God '  rest  upon  the  idea  of 
slow  and  progressive  growth  or  change.  He  un- 
doubtedly saw  that  the  only  true  renovation  of 
the  world  would  come,  not  through  reforms  of 
institutions  or  governments,  but  through  individual 
change  of  character,  effected  by  the  same  power  to 
which  Plato  appealed — the  love-power — but  a  love 
exercised  towards  Himself  as  a  perfect  and  Divine 
model.  It  was  the  '  Kingdom  of  God '  in  the  soul 
which  should  bring  on  the  kingdom  of  God  in 
human  society.  .  .  .  And  yet  ultimately  this 
Christian  system  will  be  found  at  the  basis  of  all 
these  great  movements  of  progress  in  human 
history.  But  it  began  by  aiming  at  the  indi- 
vidual, and  not  at  society;  and  aiming  alone 
at  an  entire  change  of  the  affectional  and  moral 
tendencies."^ 

The  moral  teaching  of  the  Stoics,  second  only 
to  that  of  the  Christian  religion,  had  an  effect  in 
preparing  the  way  for  the  introduction  of  humane 
principles  of  treatment  for  the  bond  and  the 
oppressed.  But  the  Stoics,  like  many  of  the 
Christians,  did  not  always  make  their  actions 
accord  with  their  principles.  Seneca  tells  of  a 
Stoic  who  amused  himself  by  feeding  his  fish  with 
pieces  of  his  mutilated  slaves.  Juvenal,  who  wrote 
when  Stoicism  was  at  the  height  of  its  influence, 


>  "  GeBta  Christi ;  or  a  History  of  Human  Progress  under 
Christianity,"  by  C.  Loring  Brace,  fourth  edition,  pp.  33,  34, 
9 


130  GREEK  AND   ROMAN   MEDICINE 

asks  "  how  a  slave  could  be  a  man,"  and  Gains,  the 
Stoical  jurist,  in  the  reign  of  Marcus  Aurelius, 
classes  slaves  with  animals. 

Constantine,  in  his  own  character,  did  not  dis- 
play the  beauties  of  the  Christian  religion,  though 
his  advisers  who  framed  his  laws  acted  under 
the  influence  of  Christian  teaching.  This  emperor 
passed  laws  in  reference  to  slavery.  He  wrote  to 
an  archbishop :  "It  has  pleased  me  for  a  long 
time  to  establish  that,  in  the  Christian  Church, 
masters  can  give  liberty  to  their  slaves,  provided 
they  do  it  in  presence  of  all  the  assembled  people 
with  the  assistance  of  Christian  priests,  and  pro- 
vided that,  in  order  to  preserve  the  memory  of  the 
fact,  some  written  document  informs  where  they 
sign  as  parties  or  as  witnesses."  In  pagan  times 
there  was  a  somewhat  similar  system  of  a  master 
being  able  to  redeem  a  slave  and  register  the 
redemption  in  one  of  the  temples. 

The  laws  of  Justinian,  influenced  largely  by  the 
teaching  of  Christianity,  did  a  great  deal  to  relieve 
the  burdens  of  slavery.  "We  do  not  transfer 
persons  from  a  free  condition  into  a  servile — we 
have  so  much  at  heart  to  raise  slaves  to  liberty." 
In  the  words  of  one  of  the  Early  Fathers  of  the 
Church,  "No  Christian  is  a  slave;  those  born  again 
are  all  brothers." 

Gladiatorial  Games  were  condemned  by  the 
Stoics,  but  these  philosophers  did  not  influence  the 
common  people.     Constantine,  in  the  year  before 


INFLUENCE   OF   CHRISTIANITY   ON   ALTRUISM         131 

his  acceptance  of  Christianity,  gave  a  multitude 
of  prisoners  as  prey  to  the  wild  beasts  of  the 
arena.  In  a.d.  325  he  promulgated  this  law : 
"  Bloody  spectacles,  in  our  present  state  of  tran- 
quillity and  domestic  peace,  do  not  please  us ; 
wherefore  we  order  that  all  gladiators  be  prohibited 
from  carrying  on  their  profession."  Human  sacri- 
fices, which  at  one  time  took  place  in  Rome, 
even  in  the  time  of  Pliny  and  Seneca,  were 
abolished  under  the  same  influence  as  checked 
gladiatorial  sports. 

Constantine  passed  laws  against  the  licentious 
plays  and  spectacles  which  flourished  in  Greece 
and  Rome  in  pagan  times. 

Seneca  wrote:  "  Monstrous  offspring  we  destroy; 
children  too,  if  weak  and  unnaturally  formed  from 
birth,  we  drown.  It  is  not  anger,  but  reason,  thus 
to  separate  the  useless  from  the  sound."  ^  Julius 
Paulus,  a  Stoic,  in  the  time  of  the  Emperor 
Severus  (a.d.  222),  held  that  the  mother  who  pro- 
cured abortion,  starved  her  child,  or  exposed  it  to 
die,  was,  in  each  case,  equally  guilty  of  murder. 
The  Christian  Fathers,  in  opposing  these  evils,  were 
acting  in  accordance  with  the  teaching  of  their 
founder,  and  they  incessantly  condemned  these 
evil  practices,  and  with  greater  and  more  far- 
reaching  power  than  the  Stoics.  Although  the 
Stoics   anticipated  many   of    the   reforms   of   the 

»  "  De  Ira,"  i,  15. 


132  GREEK  AND   ROMAN   MEDICINE 

Christians,  Stoicism  never  had  any  penetrating 
effect  on  the  masses  of  the  people,  and  differed 
in  this  respect  from  Christianity.  The  chief 
obstacle  to  the  prevention  of  the  exposure  of 
children  was  the  great  amount  of  pauperism  which 
prevailed  in  the  Eoman  Empire,  and  Christian 
emperors  and  councils  had  no  choice  but  to  allow 
many  of  these  unfortunate  children  to  be  taken  as 
slaves,  rather  than  that  they  should  perish  from 
cold  and  hunger,  or  be  torn  by  ravenous  beasts. 
The  pagan  emperors,  it  is  true,  had  done  some- 
thing to  found  orphanages,  but  these  institutions 
were  not  common  until  the  Middle  Ages.  Trajan 
in  A.D.  300  supported  5,000  children  at  the  ex- 
pense of  the  State,  and  endowments  were  created 
by  him  for  this  purpose.  Hadrian,  Antoninus^ 
and  Marcus  Aurelius  made  similar  benefactions,. 
and  Pliny  endowed  a  charity  for  poor  children. 

In  the  pre-Christian  period,  social  clubs  existed 
for  the  purpose  of  people  having  meals  together, 
helping  one  another,  and  providing  burial  funds. 
The  Emperor  Julian  condemned  the  Christians  for 
supporting  not  only  their  own  poor,  but  also  poor 
strangers  outside  their  faith.  Eor  ages  the  Church 
took  charge  of  the  poor.  Her  enemies  said  that  as 
much  pauperism  was  created  as  was  relieved,  and, 
no  doubt,  as  is  usual  in  the  distribution  of  charity,, 
the  good  done  was  not  unmixed  with  evil. 


INFLUENCE   OF   CHRISTIANITY   ON   ALTRUISM        133 

Hospitals. 

With  reference  to  the  important  question  of  the 
foundation  of  hospitals,  there  are  two  opposing 
opinions — one,  attributing  their  foundation  almost 
entirely  to  Christianity/  and  the  other  denying 
to  Christianity  any  pre-eminent  influence.^  The 
truth  lies  between  these  two  conflicting  views,  but 
nearer  to  the  statement  of  Mr.  Brace  than  of  Mr. 
McCabe.  The  truths  and  influences  of  Chris- 
tianity, in  the  mind  of  the  latter  author,  are 
obscured  by  the  many  errors  of  the  Church,  especi- 
ally in  the  Early  and  Middle  Ages ;  and  it  is  of  the 
utmost  importance  to  distinguish,  where  necessary, 
between  the  teaching  of  the  Founder  of  Christi- 
anity as  disclosed  in  the  New  Testament,  and  the 
teaching  of  the  Church  which  made  many  very 
evident  errors,  and  whose  practice  soon  became 
different  from  that  inculcated  by  its  Founder, 
so  that  at  times  the  Christianity  of  the  Church 
was  as  different  from  Christ's  teaching  as  the 
vine  of  Sodom  from  the  grapes  of  Eshcol.  The 
fact  that  Christianity  emerged  from  this  eclipse 
points  to  it  as  something  more  than  a  humanly 
devised  system. 

In  very  early  times,  the  sick  were  allowed  to 
remain  at  the  temples  for  the  treatment  of  their 
diseases,  and  medical  students  also  attended  for 

1  Vide  "  Gesta  Ohristi,"  Brace. 

2  Vide  "  The  Bible  in  Europe,"  Joseph  McCabe. 


134  GREEK  AND   EOMAN   MEDICINE 

instruction.  This  system  was  the  hospital  system 
of  later  times,  although  the  temples  were  not 
hospitals  in  the  present  sense  of  the  word.  The 
system  in  vogue  in  the  temples  of  ^sculapius 
in  Greece  and  Eome  has  already  been  described 
in  this  book,  but  the  temples  of  Saturn  served 
the  same  purpose  in  Egypt  four  thousand  years 
before  Christ.  Professor  Ebers  of  Leipzig,  a  high 
authority  on  the  subject,  says  that  Heliopolis  un- 
doubtedly had  a  clinique  in  connection  with  the 
temple.  The  Emperor  Asoka  founded  many  hos- 
pitals in  Hindustan,  and  Buddhists  and  Moham- 
medans both  possessed  hospitals  ("Encyclopaedia 
Britannica  "). 

Patients  were  attracted  to  temples,  not  only  by 
receiving  the  services  of  the  priest-physicians,  but 
also  in  the  superstitious  belief  that  special  virtue 
attached  to  the  precincts  of  sacred  buildings. 
Thus,  in  the  temples  of  ^sculapius,  sick  people 
tried  to  get  as  near  to  the  altar  as  possible.  "  It 
may  fairly  be  surmised  that  the  disuse  of  these 
temples  in  Christian  times  made  the  necessity  of 
hospitals  more  apparent,  and  so  led  to  their  in- 
stitution, in  much  the  same  way  as  in  this  country 
the  suppression  of  monasteries,  which  had  largely 
relieved  the  indigent  poor,  made  the  necessity  of 
poor  laws  immediately  evident."  ^  During  Hadrian's 
reign  the  first  notice  of  a  military  hospital  appears. 

1  "  Smith's  Dictionary  of  Greek  and  Eoman  Antiquity." 


INFLUENCE   OF   CHRISTIANITY  ON   ALTRUISM        135 

The  iatria,  or  taberncB  medicce,  described  by 
Galen  and  others,  were  not  for  in-patients,  but 
of  the  nature  of  dispensaries  for  the  reception  of 
out-patients.  Seneca  refers  to  vaietudinaria,  rooms 
set  aside  for  the  sick  in  large  private  houses.  The 
first  hospital  in  Eome  in  Christian  times  was 
founded  by  Fabiola,  a  wealthy  lady,  at  the  end  of 
the  fourth  century.  Attached  to  it  was  a  convales- 
cent home  in  the  country.  Pulcheria,  later,  built 
and  endowed  several  hospitals  at  Constantinople, 
and  these  subsequently  increased  in  number.  Paul- 
ine abandoned  wealth  and  social  position  and  went 
to  Jerusalem,  and  there  established  a  hospital  and 
sisterhood  under  the  direction  of  St.  Jerome.  St. 
Augustine  founded  a  hospital  at  Hippo.  McCabe 
states  justly :  "  In  the  new  religious  order  a 
philanthropic  heroism  was  evolved  that  was 
certainly  new  to  Europe.  In  the  whole  story  of 
Stoicism  there  is  no  figure  like  that  of  a 
Catherine  of  Sienna  sucking  the  sores  of  a  leper, 
or  a  Vincent  de  Paul."  It  appears  evident 
that  Christianity  was  an  important  factor  in  the 
foundation  of  hospitals  and  charitable  institu- 
tions, not  directly,  but  from  its  beneficent  in- 
fluence on  the  character  of  individuals;  and  the 
Eoman  Church,  in  this  respect,  acted  in  con- 
formity with  the  teachings  of  the  Christian  faith. 

Of  greater  importance  is  the  consideration  of 
the  influence  of  Christianity,  and  of  the  Church, 
on  the   investigation  and  elimination  of   disease. 


136  GREEK  AND   ROMAN   MEDICINE 

In  this  matter  the  Church  deserves  the  severest 
censure.  It  is  no  exaggeration  to  say  that  she 
hindered  the  scientific  progress  of  the  world  for 
centuries.  She  appHed  to  the  explanation  of  the 
causation  of  disease,  the  demon  theories  inherited 
from  Egypt,  Persia,  and  the  East.  The  Bible 
itself  reflects  the  viev^s  on  demonology  current  at 
the  time  of  the  events  recorded.  If  demons  were 
the  cause  of  disease,  logically  the  treatment  of 
diseases  should  have  been  in  the  hands  of  priests, 
not  of  physicians.  The  priests  held  that  they 
were  the  proper  people  to  interpret  the  will  of  the 
Almighty ;  diseases  were  direct  dispensations  of 
Providence. 

"It  is  demons,"  says  Origen,  "which  produce 
famine,  unfruitfulness,  corruptions  of  the  air,  and 
pestilence.  They  hover  concealed  in  clouds,  in 
the  lower  atmosphere,  and  are  attracted  by  the 
blood  and  incense  which  the  heathen  offer  to  them 
as  gods."^  "  All  diseases  of  Christians,"  wrote 
Augustine,  "  are  to  be  ascribed  to  these  demons  : 
chiefly  do  they  torment  fresh-baptized  Christians, 
yea!  even  the  guiltless  new-born  infants."  Hippo- 
crates, long  before  the  Christian  era,  wrote  with 
great  wisdom  in  reference  to  the  so-called  sacred 
diseases :  "  To  me  it  appears  that  such  affec- 
tions are  just  as  much  divine  as  all  others  are, 
and  that  no  one  disease  is  either  more  divine  or 

^  Origen,  "  Contra  Celsum,"  lib.  vii. 


INFLUENCE   OF   CHEISTIANITY   ON   ALTRUISM         137 

more  human  than  another;  but  all  are  alike  divine, 
for  each  has  its  own  nature,  and  no  one  arises 
without  a  natural  cause."  ^ 

The  devil  might  be  driven  out  in  disgust,  it  was 
thought,  by  the  use  of  disgusting  materials — ordure, 
the  grease  made  from  executed  criminals,  the  livers 
of  toads,  the  blood  of  rats,  and  so  on.  The  same 
belief  in  demoniacal  possession  led  to  the  most 
inhuman  treatment  of  lunatics,  and  the  Church 
in  this  respect  is  put  to  shame  when  we  compare 
its  action  with  the  wiser  and  more  humane  practice 
of  the  Moors.  This  belief  helped  to  strangle  medi- 
cal progress  for  centuries,  and  is  directly  attribut- 
able to  the  Church.  As  late  as  1583,  the  Jesuit 
fathers  at  Vienna  boasted  that  they  had  cast  out 
12,642  devils.  That  God  dispenses  both  health 
and  disease  is  a  very  different  belief  from  that  in- 
volved in  "  demoniacal  possession."  Travellers  in 
remote  parts  of  the  East  at  the  present  day  tell  of 
alleged  cases  of  demoniacal  possession,  but  investi- 
gation does  not  reveal  any  difference  between  these 
•cases  and  epilepsy  or  acute  mania. 

In  the  first  centuries  of  the  Christian  era  men 
demanded  overt  signs  of  the  favour  of  God,  and 
the  objects  of  veneration  kept  in  the  churches  and 
monasteries  were  held  to  be  capable  of  curing 
•disease.  The  Latin  Church  had  either  a  saint 
or   a   relic    of    a    saint   to   cure    nearly   every   ill 

^  Adams's  translation  "  Hippoc,"  vol.  i,  p.  216. 


138  GEEEK  AND   EOMAN   MEDICINE 

that  flesh  is  heir  to.  St.  Apollonia  was  invoked 
against  toothache;  St.  Avertin  against  lunacy; 
St.  Benedict  against  stone;  St.  Clara  against 
sore  eyes ;  St.  Herbert  in  hydrophobia ;  St.  John 
in  epilepsy ;  St.  Maur  in  gout ;  St.  Pernel  in 
ague ;  St.  Genevieve  in  fever ;  St.  Sebastian  in 
plague ;  St.  Ottila  for  diseases  of  the  head ;  St. 
Blazius  for  the  neck ;  St.  Laurence  and  St. 
Erasmus  for  the  body ;  St.  Eochus  and  St.  John 
for  diseases  of  the  legs  and  feet.  St.  Margaret 
was  invoked  for  diseases  of  children  and  the 
dangers  of  childbirth. 

What  the  influence  of  Christ's  life  on  earth  on  the 
medical  art  of  His  time  was  is  a  difficult  question. 
It  must  be  remembered  that  He  came  to  save  the 
souls  and  not  the  bodies  of  men,  not  to  rapidly 
alter  social  conditions  nor  to  teach  science.  The 
eternal  life  of  man  was  the  subject  of  transcend- 
ent importance,  and  it  is  no  doubt  true  that 
many  of  the  early  Christians  neglected  their 
bodies  for  the  cure  of  their  souls.  As  against 
this,  the  gospel  of  love  taught  that  all  men  are 
brothers,  both  bond  and  free,  and  this  led  to 
mutual  help  in  physical  sufiering,  and  to  the 
foundation  of  charitable  institutions.  In  the  times 
of  persecution  of  the  Christians  many  of  them 
welcomed  suffering  and  death  as  the  portal  to 
eternal  bliss. 

It  has  been  asserted  that  the  miraculous  cures 
wrought  by  Christ  for  His  own  purposes  were  an 


INFLUENCE   OF   CHBISTIANITY  ON   ALTRUISM         139 

intimation  to  His  followers  to  neglect  the  ordinary 
means  of  natural  cure,  and  that  this  placed  a 
Christian  doctor  in  the  position  of  having  to 
abandon  his  calling.  This  is  not  so.  To  St.  Luke 
— a  Christian  physician  and  the  writer  of  the 
third  Gospel  and  the  Acts  of  the  Apostles — the 
performance  by  Christ  of  miracles  of  healing  pre- 
sented no  difficulties,  for  he  was  the  travelling 
medical  adviser  of  St.  Paul,  and  accompanied 
him  on  three  journeys,  from  Troas  to  Philippi, 
from  Philippi  to  Jerusalem,  and  from  Csesarea 
to  Eome  (a.d.  62).  St.  Paul  wrote :  "  For  we 
would  not,  brethren,  have  you  ignorant  of  our 
trouble  which  came  to  us  in  Asia,  that  we  were 
pressed  out  of  measure,  above  strength,  insomuch 
that  we  despaired  even  of  life,  but  we  had  the 
sentence  of  death  in  ourselves,  that  we  should  not 
trust  in  ourselves,  but  in  God,  which  raiseth  the 
dead :  who  delivered  us  from  so  great  a  death,  and 
doth  deliver :  in  whom  we  trust  that  He  will  yet 
deliver  us."  St.  Paul  exercised  faith,  but  also 
used  the  means  of  cure  prescribed  by  "  the  beloved 
physician."  In  a  very  scholarly  book  published 
by  the  Dublin  University  Press  in  1882,  the  Eev. 
W.  K.  Hobart,  LL.D.,  shows  that  St.  Luke  was 
acquainted  with  the  technical  medical  terms  of 
the  Greek  medical  writers.  St.  Luke  was  an 
Asiatic  Greek.  Dr.  Hobart  writes :  "  Finally,  it 
should  not  be  left  out  of  account  that,  in  any 
illness   from  which  he  might   be   suffering,  there 


140  greek:  and  roman  medicine 

was  no  one  to  whom  St.  Paul  would  be  likely  to 
apply  with  such  confidence  as  to  St.  Luke,  for  it 
is  probable  that,  in  the  whole  extent  of  the  Koman 
Empire,  the  only  Christian  physician  at  this  time 
was  St.  Luke."  In  later  years  the  pretence  of 
performing  miracles  to  cure  diseases  had  a  great 
effect  in  advancing  superstition  and  retarding 
scientific  investigation. 

Tacitus  and  Suetonius  record  miracles  alleged 
to  have  been  performed  by  Vespasian.  He  is  said 
to  have  anointed  the  eyes  of  a  blind  man  at 
Alexandria  with  the  royal  spittle,  and  to  have 
restored  his  sight.  Another  case  was  that  of  a  man 
who  had  lost  the  use  of  his  hands,  and  Vespasian 
touched  them  with  his  foot  and  thus  restored  their 
function.  It  is  interesting  to  follow  the  career  of 
Proclus,  the  last  rector  of  the  Neoplatonic  School, 
"  whose  life,"  says  G-ibbon,  "  with  that  of  his 
scholar  Isidore,  composed  by  two  of  their  most 
learned  disciples,  exhibits  a  most  deplorable  picture 
of  the  second  childhood  of  human  reason."  By 
long  fasting  and  prayer  Proclus  pretended  to 
possess  the  supernatural  power  of  expelling  all 
diseases. 

The  priests  of  the  Church  denounced  the 
practice  of  Anatomy,  and  so  changed  the  pro- 
gress made  by  the  Alexandrian  School,  and  by 
men  like  Galfen,  into  the  ignorance  of  a  thousand 
years.  The  body  was  the  temple  of  the  Holy 
Ghost,  and  should  not  therefore  be  desecrated  by 


INFLUENCE   OF   CHRISTIANITY  ON   ALTRUISM         141 

dissection.  "  Strangers'  rests  "  and  hospitals  were 
connected  with  the  monasteries,  and  were  ex- 
ceedingly useful,  notably  in  the  time  of  the 
Crusades,  but  these  Church  institutions  were  in 
a  very  insanitary  condition,  for  the  maxim  that 
cleanliness  is  next  to  godliness  had  little  applica- 
tion among  the  religious  orders  of  the  Middle  Ages. 
Dr.  Walsh  attempts  to  show  that  the  Eeformers 
blackened  the  fair  fame  of  the  Church  they  had 
left,  and  states  that  it  is  to  "  this  unfortunate 
state  of  affairs,  and  not  real  opposition  on  the 
part  of  the  Popes  to  science,"  that  we  owe  the 
belief  in  "  the  supposed  opposition  between  the 
Church  and  Science."  ^  That  the  Popes  did  some- 
thing to  foster  medical  science  in  a  spasmodic 
kind  of  way,  that  papal  physicians  were  appointed 
and  that  the  Church  exercised  control  over  some 
seats  of  learning  may  be  freely  admitted.  That 
the  monasteries  preserved  some  of  the  Latin 
classics  that  they  were  not  all  corrupt,  and  that 
all  monks  were  not  ignorant  and  idle,  are  facts 
beyond  dispute.  No  doubt,  too,  the  enemies  of 
Christianity  have  overstated  their  case,  but  when 
all  is  said,  the  fact  remains  that  the  Church  enjoyed 
great  opportunities  for  promoting  knowledge  and 
investigating  disease,  and  failed  to  avail  itself  of 


i"The  Popes  and  Science:  The  History  of  the  Papal 
Eelations  to  Science  during  the  Middle  Ages,  and  down  to 
our  own  Time,"  J.  J.  Walsh,  M.D.,  1911. 


142  GREEK  AND   ROMAN   MEDICINE 

them  to  such  an  extent  that  for  ages  no  real  pro- 
gress was  made.  This  is  certainly  not  an  extreme 
opinion.  It  would  be  nearer  the  truth  to  say  that 
not  only  was  no  progress  made,  but  that  the 
advances  made  by  Hippocrates,  by  the  school  of 
Alexandria,  by  Celsus,  and  by  Galen,  were  lost. 

In  conclusion,  in  spite  of  the  dreadful  blunders 
and  perversions  of  the  Church  in  the  Early  and 
Middle  Ages,  and  the  partial  eclipse  which 
Christianity  suffered,  the  teaching  of  its  Founder 
slowly  but  surely  ended  the  harsh  and  cruel  ways 
of  the  pagans,  and  was  the  prime  factor  in  pro- 
moting the  altruism  of  later  times,  of  which 
medical  knowledge  and  medical  service  form  a 
very  important  part. 


143 


CHAPTER  XII. 

GYMNASIA  AND  BATHS. 

Gymnastics — Vitruvius— Opinions  of  Ancient  Physicians  on 
Gymnastics —The  Athletes — The  Baths — Description  of 
Baths  at  Pompeii — Thermae — Baths  of  Caracalla. 

G-YMNASTICS. 

Gymnastics  were  held  in  such  high  repute  in 
ancient  Greece  that  physical  training  occupied  as 
much  time  in  the  education  of  boys  as  all  their 
other  studies,  and  was  continued  through  life  with 
modifications  to  suit  the  altering  requirements  of 
age  and  occupation.  The  Greeks  fully  recognized 
that  mental  culture  could  not  reach  its  highest 
perfection  if  the  development  of  the  body  were 
neglected.  Lucian  attributes  not  only  the  bodily 
grace  of  the  Ancient  Greeks,  but  also  their  mental 
pre-eminence,  to  the  gymnastic  exercises  which 
they  practised.  They  were  also  an  important  factor 
in  the  excellence  of  Greek  sculpture,  and  probably 
the  most  important  part  of  their  medical  treatment. 

Unfortunately  the  baths  of  the  Eomans  and 
the  gymnasia  of  the  Greeks  became  in  time 
the  haunts  of  the  lazy  and  voluptuous.  The 
gymnastic    exercises    of    the    Greeks    date    from 


144  GEEEK  AND   ROMAN   MEDICINE 

very  early  times,  and  at  first  were  of  a  warlike 
nature,  and  not  reduced  to  a  system.  Each  town 
possessed  a  gymnasium,  and  three  very  important 
ones  were  situated  at  Athens. 

Vitruvius  describes  the  general  plan  of  an  ancient 
gymnasium.  It  comprised  a  great  stadium  capable 
of  accommodating  a  vast  concourse  of  spectators, 
many  porticoes  where  athletes  exercised  and 
philosophers  and  sages  held  discussions  and 
lectured,  walks  and  shady  groves,  and  baths  and 
anointing  rooms.  The  buildings,  in  true  Grecian 
fashion,  were  made  very  beautiful,  being  adorned 
with  statues  and  works  of  art,  and  situated  in 
pleasant  surroundings. 

Up  to  the  age  of  16  boys  were  instructed  in  gym- 
nastics, in  music  and  in  grammar,  and  from  16  to  18 
in  gymnastics  alone.  The  laws  of  Solon  regulated 
the  use  of  the  gymnasia,  and  for  very  many  years 
these  laws  were  strictly  enforced.  It  appears  that 
married  women  did  not  attend  the  gymnasia,  and 
unmarried  women  only  in  some  parts  of  Greece, 
such  as  Sparta,  but  this  custom  was  relaxed  in 
later  years. 

The  office  of  Gymnasiarch  (Superintendent  of 
Gymnasia)  was  one  of  great  honour,  but  involved 
also  a  great  deal  of  expense  to  the  holder  of  the 
office.  He  wore  a  purple  cloak  and  white  shoes. 
Officers  were  appointed  to  supervise  the  morals 
and  conduct  of  the  boys  and  youths,  and  the 
Gymnasiarch   had  power   to   expel   people   whose 


GYMNASIA   AND   BATHS  145 

teaching   or   example    might    be    injm'ious    to    the 
young. 

Galen  relates  that  the  chief  teachers  of  the  gym- 
nasia were  capable  of  prescribing  suitable  exercises, 
and  thus  had  powers  of  medical  supervision. 

Before  exercises  were  commenced,  the  body  was 
anointed,  and  fine  sand  or  dust  applied.  Eegulation 
of  the  diet  was  considered  of  very  great  importance. 

The  games  of  the  gymnasia  were  many  and 
various,  including  games  of  ball,  tug-of-war,  top" 
spinning,  and  a  game  in  which  five  stones  were 
placed  on  the  back  of  the  hand,  thrown  upwards, 
and  caught  in  the  palm.  One  kind  of  game  or 
exercise  consisted  in  throwing  a  rope  over  a  high 
post,  when  two  boys  took  the  ends  of  the  rope, 
one  boy  on  each  side,  the  one  trying  to  pull  the 
other  up.  The  most  important  exercises,  however, 
were  running,  walking,  throwing  the  discus,  jump- 
ing, wrestling,  boxing,  and  dancing. 

The  first  public  gymnasium  in  Eome  was  built 
by  the  Emperor  Nero.  In  the  time  of  the  Eepublic 
Greek  exercises  were  held  in  contempt  by  the 
Eomans,  and  the  first  gymnasia  in  Eome  were 
small,  and  connected  only  with  private  houses  or 
villas. 

The  g;\'mnasia  were  dedicated  to  Apollo,  the  god 
of  healing,  and  exercises  were  considered  of  greater 
importance  for  restoring  health  than  medicinal 
treatment.  The  directors  of  the  gymnasia  were 
in  reality  physicians,  and  acted  as  such.  Plato 
10 


146  GREEK  AND   ROMAN   MEDICINE 

states  that  one  of  these,  Iccus  by  name,  was  the 
inventor  of  medical  gymnastics.  As  in  our  own 
day,  many  creditable  gymnasts,  originally  weak  of 
body,  had  perfected  their  strength  by  systematic 
exercise  and  careful  dieting. 

Hippocrates  had  occasion  to  protest  against 
prolonged  and  laborious  exercises,  and  excessive 
massage,  and  recommended  his  own  system,  that 
of  moderation.  He  applied  massage  to  reduce 
swellings  in  suitable  cases,  and  also  recognized 
that  the  same  treatment  was  capable  of  increasing 
nutrition,  and  of  producing  increased  growth  and 
development.  Hippocrates  described  exercises  of 
the  kind  now  known  as  Swedish,  consisting  of  free 
movements  without  resistance. 

Galen  generally  followed  the  teaching  of  Hippo- 
crates on  gymnastics,  and  wrote  a  whole  book  on 
the  merits  of  using  the  strigil.  Oribasius,  and 
Antyllus,  too,  in  their  writings,  recommend  special 
exercises  which  appealed  to  their  judgment. 

The  ancient  physicians  had  great  faith  in  the 
efficacy  of  exercises  in  cases  of  di'opsy,  and  Ascle- 
piades  employed  this  method  of  treatment  very 
extensively,  using  also  pleasant  medicaments,  so 
that  Pliny  said  "  this  physician  made  himself  the 
delight  of  mankind."  Patients  suffering  from 
consumption  were  commonly  sent  to  Alexandria 
to  benefit  from  the  climate,  but  Celsus  con- 
sidered the  sea  voyage  most  beneficial  because  the 
patient  was  exercised  bodily  by  the  motion  of  the 


GYMNASIA   AND   BATHS  147 

ship.  Germanicus  was  cured  by  riding  exercise, 
and  Cicero  was  strengthened  by  traveUing  and 
massage. 

From  the  writings  of  G-reek  and  Roman 
physicians  there  is  no  other  conclusion  to  be 
"drawn  but  that  exercises  and  gymnastics  were 
in  great  vogue  for  medical  purposes,  and  were  of 
the  utmost  benefit.  It  seems  likely  that  the 
exercises  of  the  Greeks,  and  the  baths  of  the 
Bomans,  both  freed  from  the  abuses  which  took 
away  in  time  from  their  merits,  could  be  adopted 
at  the  present  day  and  encouraged  by  physicians 
with  great  advantage  to  their  patients.  There  is 
a  strong  tendency  at  present  in  that  direction. 

Belonging  to  a  different  class  were  the  contests 
of  the  athletes,  who,  except  in  very  early  times 
in  Greece,  were  people  of  the  baser  sort  whose 
bodies  were  developed  to  the  neglect  of  their 
minds.  Those  who  underwent  the  severest  train- 
ing ate  enormous  quantities  of  meat,  and  tried  to 
cultivate  bulk  and  weight  rather  than  strength. 
They  did  not  compete,  as  a  rule,  after  the  age 
of  thirty-five  years.  Euripides  considered  these 
athletes  an  encumbrance  on  the  State.  Plato 
said  they  were  very  subject  to  disease,  without 
grace  of  manner,  violent,  and  brutal.  Aristotle 
declared  that  the  athletes  had  not  the  active 
vigour   that  good   citizens   ought    to   possess. 

The  athletes  and  gladiators  of  Rome  were  mostly 
Greeks.     Both  Plutarch  and   Galen  deride  them. 


148  GREEK  AND   EOMAN   MEDICINE 

Tlie  former  condemned  the  whole  business,  and 
Gralen  wrote  six  chapters  to  warn  young  men 
against  becoming  athletes.  He  said  that  man  is 
linked  to  the  divine  and  also  to  the  lower  animals, 
that  the  link  with  animals  was  developed  by- 
athletics,  and  that  athletes  were  immoderate  in 
eating,  sleeping,  and  exertion,  and  were  therefore 
unhealthy,  and  more  liable  than  other  people  to 
disease  and  sudden  death.  Their  brutal  strength 
was  of  use  only  on  rare  occasions  and  unsuited  for 
war,  or  for  useful  work. 

In  the  time  of  St.  Paul,  the  athletes  were 
evidently  abstemious,  for  he  wrote  "  every  man 
who  striveth  in  the  games  is  temperate  in  all 
things,"  but  in  Rome,  at  most  periods  of  their 
history  this  class  of  men  was  notorious  for  gross- 
ness  and  brutality. 

Baths  {Balnece). 

Greek  Baths. — In  Greece  from  very  early  times 
inability  to  read  and  to  swim  were  considered  the 
marks  of  the  ignorant.  In  Homer's  time  over- 
indulgence in  warm  baths  was  considered  efiemi- 
nate.  ^  The  system  of  bathing  was  never  so 
complete  in  Greece  as  in  Home,  but  in  the 
former  country  there  were  both  public  and  private 
baths,  and  ancient  Greek  vases  display  pictures 
of  swimming-baths  and  shower-baths,  and  also  of 

^  Od.  viii,  249. 


GYMNASIA   AND   BATHS  149 

large  basins  for  men  and  for  women  round  which 
they  stood  to  bathe.  The  Greek  baths  were 
near  the  gymnasia.  After  the  bath,  the  bathers 
were  anointed  with  oil  and  took  refreshments. 
Sometimes  a  material  consisting  of  a  lye  made 
of  lime  or  wood-ashes,  of  nitrum  and  of  fuller's 
earth  was  applied  to  the  body.  Towels  and  strigils 
were  employed  for  rubbing  and  scraping  after  the 
anointing ;  the  strigil  was,  as  a  rule,  made  of  iron. 

Natural  warm  springs  used  for  curative  purposes 
are  mentioned  by  ancient  Greek  writers. 

Boman  Baths. — Bathing,  which  was  not  much 
in  vogue  in  Bome  in  the  most  ancient  times,  was 
more  common  during  the  Republic,  and  became  a 
factor  in  the  decay  of  the  nation  in  the  time  of  the 
Empire.  Seneca  informs  us  that  the  ancient 
Romans  washed  their  arms  and  legs  every  day  and 
their  whole  bodies  once  a  week.  The  bath-room 
was  near  the  kitchen  in  the  Roman  house,  to  be 
convenient  for  the  supply  of  hot  water.  Scipio's 
bath  was  "  small  and  dark  after  the  manner  of  the 
ancients."  In  the  time  of  Cicero,  the  use  of  baths, 
both  public  and  private,  was  general,  and  hot-water 
and  hot-air  baths  are  both  mentioned.  It  has  been 
computed  that  there  were  856  baths  in  Rome  in 
the  time  of  Constantine. 

The  public  baths  were  at  first  used  only  by  the 
poor,  but  the  mother  of  Augustus  went  to  the  public 
bath,  and  in  time  even  the  emperors  patronized 
them.    The  baths  were  opened  at  sunrise  and  closed 


150  GEEEK  AND   EOMAN   MEDICINE 

at  sunset  except  in  the  time  of  Alexander  Severus, 
when  they  were  open  also  at  night.  The  charges 
for  admission  were  very  low.  The  ringing  of  a 
bell  announced  that  the  bath  was  ready.  Baths 
were  taken  seven  or  eight  times  in  succession 
when  the  people  were  given  to  luxury,  and  some  of 
them  wasted  almost  the  whole  day  there.  The 
voluptuaries  of  the  Empire  bathed  not  only  before 
the  principal  meal  of  the  day,  but  also  afterwards 
to  promote  digestion  as  they  thought.  The  per- 
spiration induced  by  the  bath  took  the  place  of 
honest  sweat  induced  by  work  or  exercise,  and 
excessive  hot-bathing  and  perspiring  in  some  cases 
had  a  fatal  ending. 

Gralen  and  Celsus  differ  in  their  directions  to 
bathers.  Galen  recommended  first  the  hot  -  air 
bath,  next  the  hot-water  bath,  then  the  cold  bath 
and  finally  rubbing ;  Celsus  recommended  sweating 
first  in  the  tepid  chamber,  then  in  the  hot  chamber, 
and  next  the  pouring  of  hot,  then  tepid,  and  lastly, 
cold  water  over  the  head,  followed  by  the  use  of 
the  strigil,  and  anointing  and  rubbing. 

The  plan  of  the  baths  at  Pompeii,  which  was 
largely  a  pleasure  resort,  is  typical  of  the  public 
baths  that  were  in  general  use.  These  baths  had 
several  entrances,  and  the  principal  one  led  to  a 
covered  portico  from  which  a  lavatory  opened. 
The  portico  ran  round  three  sides  of  a  courtyard 
{atriimi)  in  which  the  attendants  waited,  and  it 
was    also   the   exercise-yard  for   the  young  men. 


GYMNASIA    AND   BATHS  151 

Advertisements  of  the  theatres  and  gladiatorial 
shows  were  exhibited  on  the  walls  of  the  atrium. 
The  undressing  room  was  also  the  reception  room 
and  meeting-place.  The  bathers'  garments  were 
handed  over  for  custody  to  slaves,  who  were,  as  a 
general  rule,  a  very  dishonest  class.  The  frigi- 
darium  contained  a  cold  bath  13  ft.  8  in.  in 
diameter,  and  a  little  less  than  4  ft.  deep.  It 
had  two  marble  steps,  and  a  seat  under  water  10  in. 
from  the  bottom.  Water  ran  into  the  bath  through 
a  bronze  spout,  and  there  was  a  conduit  for  the 
outflow,  and  an  overflow  pipe.  The  frigidarium 
opened  into  the  tepidarium  which  was  heated  with 
hot  air  from  furnaces,  and  furnished  with  a  char- 
coal brazier  and  benches.  The  brazier  at  Pompeii 
was  7  ft.  long  and  2J  ft.  broad.  The  tepidarium 
was  commonly  a  beautifully  ornamented  apartment, 
while  the  anointing-room  was  conveniently  situated 
off  it.  Pliny  has  described  the  various  unguents 
used  by  wealthy  and  luxurious  Eomans.  From 
the  tepidarium  the  bather  might  enter  the  cal- 
darium  or  sweating  room,  an  apartment  con- 
structed with  double  walls  and  floor,  between 
which  hot  air  was  made  to  pass.  This  room 
contained  a  lahrum,  or  circular  marble  basin,  con- 
taining cold  water  for  pouring  over  the  head  before 
the  bather  left  the  caldarium.  The  method  of 
heating  rooms  by  passing  hot  air  between  the 
"  hanging  "  and  the  lower  floor  was  in  use  in  the 
better  class  of  houses,  and  the  device  can  at  present 


152  GREEK   AND   EOMAN   MEDICINE 

be  seen  in  some  of  the  buildings  on  the  Palatine 
Hill  in  Borne,  and  in  the  ruins  of  the  great  Baths 
of  Caracalla.  After  a  course  of  sweating  the 
bather  had  the  sweat  removed  from  his  body  by 
the  strigil,  in  much  the  same  way  as  a  horse  is 
scraped  with  a  bent  piece  of  hoop-iron  by  a  groom. 
The  guttus  was  a  small  vessel  with  a  narrow  neck 
adapted  for  dropping  oil  on  the  strigil  to  lubricate 
its  working  edge.  Pliny  states  that  invalids  used 
sponges  instead  of  strigils.  Bubbing  with  towels 
followed  the  use  of  the  strigil,  and  the  bather 
finally  lounged  in  the  tepidarium  for  a  varying 
period  before  entering  the  outer  air. 

The  boilers  in  use  at  Pompeii  were  three  in 
number.  The  lowest  one,  immediately  over  the 
furnace,  contained  the  hottest  water.  The  next 
above  and  a  short  distance  to  the  side  held  tepid 
water,  and  the  farthest  removed  contained  cold 
water.  This  system  was  economical  because  as 
the  very  hot  water  was  drawn  off  from  the  lowest 
boiler  a  supply  of  tepid  water  flowed  down  from 
the  boiler  next  above,  and  from  the  highest  to 
the  middle  boiler. 

A  smaller  suite  of  bathing  apartments  adjoining 
the  men's  establishment  was  for  the  use  of  women. 

The  most  important  baths  formed  only  a  part 
of  the  great  establishments  called  thermcB. 
Adjoining  the  baths  of  the  thermae  were  a  gymna- 
sium for  sports  and  exercises,  a  library  for  the 
studious,  lounging  places    for    the    idle,  halls   for 


GYMNASIA    AND    BATHS 


153 


poets  and  philosophers,  in  which  they  declaimed 
and  lectured,  museums  of  art,  and  sometimes 
shady  groves.  These  complete  establishments 
were  first  erected  by  Marcus  Agrippa  in  the  time 
of  Augustus.  Succeeding  emperors  vied  with  each 
other  in  providing  magnificent  thermae,  and  the 
ruins  of  the  Baths  of  Caracalla  remain  in  a 
wonderful  state  of  preservation  to  this  day.  The 
building  of  these  baths  began  in  a.d.  216.  The 
structure,  1,050  ft.  long  and  1,390  ft.  broad,  was  on 
a  scale  of  almost  incredible  magnificence.  Price- 
less statues  and  rare  objects  of  art  have  been 
unearthed  from  the  ruins.  In  recent  years  exca- 
vations have  revealed  a  complicated  system  of 
subterranean  corridors  and  galleries  which  existed 
for  the  purpose  of  carrying  leaden  water-pipes  to 
the  baths,  and  providing  a  passage-way  for  the 
host  of  slaves  who  acted  as  bath-attendants.  The 
great  buildings  were  well  lit  by  windows  in  the 
walls  of  the  courtyards,  and  these  openings  also 
allowed  for  ventilation.  A  great  stadium  and  beau- 
tiful gardens  adjoined  the  Baths  of  Caracalla.  In 
the  north-west  section  of  these  baths  Alessio  Valle 
has  very  recently  discovered  the  remains  of  a  great 
public  library.  When  Caracalla  pillaged  Alexan- 
dria he  probably  carried  off  many  of  the  books 
from  the  famous  library  there  to  enrich  his  baths. 
The  ruins  of  the  library  in  the  Baths  of  Caracalla 
reveal  circular  tiers  of  galleries  for  the  display  of 
manuscripts  and  papyri.     There  were  500   rooms 


154  GREEK   AND   ROMAN   MEDICINE 

round  these  baths.  The  great  hall  had  a  ceiling 
made  in  one  span,  and  the  roof  was  an  early 
example  of  reinforced  concrete,  for  it  was  made 
of  concrete  in  which  bronze  bars  were  laid.  The 
lead  for  the  water-pipes  was  probably  brought 
from  Cornwall. 

The  Thermae  of  Diocletian  could  accommodate 
3,200  bathers.  Its  tepidarium  was  300  ft.  long 
by  nearly  100  ft.  wide,  "  vaulted  in  three  bays  with 
simple  quadripartite  groining,  which  springs  from 
eight  monolithic  columns  of  Egyptian  granite 
about  50  ft.  high  and  5  ft.  in  diameter " 
(Middleton). 

From  the  medical  point  of  view,  these  great 
bathing  institutions  were  capable  of  being  used  for 
the  treatment  of  various  diseases,  and  for  physical 
culture.  No  doubt,  they  were  extensively  em- 
ployed for  these  purposes  and  with  good  results,  but 
their  legitimate  use  became  increasingly  limited, 
and  abuse  of  them  was  a  prime  factor  in  promot- 
ing national  decay.  To  show  to  what  an  extent 
luxurious  bathing  was  carried  in  some  instances, 
it  is  interesting  to  read  that  baths  were  taken 
sometimes  in  warm  perfumes,  in  saffron  oil,  and 
that  the  voluptuous  Poppsea  soothed  her  skin  in 
baths  of  milk  drawn  from  a  herd  of  500  she-asses. 


155 


CHAPTEE  XIII. 

SANITATION. 

Water-supply — Its  extent — The  Aqueducts — Distribution  in 
city — Drainage — Disposal  of  the  Dead — Cremation  and 
Burial — Catacombs — Public  Health  Eegulations. 

The  Water-supply. 

In  ancient  Greece,  the  cities  were  supplied 
with  water  from  springs  over  which  beautiful  foun- 
tains were  erected.  The  Greek  aqueducts  were 
not  on  the  same  grand  scale  as  the  Roman,  but 
were  usually  rectangular  channels  cut  in  the 
rock,  or  made  of  pipes  or  masonry.  Great  care 
was  taken  in  the  supervision  of  these  public 
works. 

The  first  Roman  aqueduct,  according  to  Fron- 
tinus,  dates  from  312  B.C. 

Pliny  wrote  of  the  Glaudian  aqueduct :  "  But  if 
anyone  will  carefully  calculate  the  quantity  of 
the  public  supply  of  water,  for  baths,  reservoirs, 
houses,  trenches,  gardens  and  suburban  villas,  and, 
along  the  distance  which  it  traverses,  the  arches 
built,  the  mountains  perforated,  the  valleys  levelled, 
he  will  confess  that  there  never  was  anything  more 
wonderful  in  the  whole  world." 


156  GEEEK   AND   EOMAN    MEDICINE 

Frontinus,  who  was  controller  of  the  aqueducts 
in  the  time  of  Nerva  and  of  Trajan,  describes  nine 
aqueducts,  of  which  four  belonged  to  the  days  of 
the  Eepublic,  and  five  to  the  reigns  of  Augustus 
and  Claudius. 

"  The  total  water-supply  of  Kome  has  been 
estimated  at  332,306,624  gallons  a  day,  or,  taking 
the  population  at  a  million,  332  gallons  a  head. 
Forty  gallons  a  day  is  now  considered  sufficient."^ 

The  ancient  Aqua  Virgo  at  the  present  day 
supplies  the  magnificent  Fontana  di  Trevi,  and 
the  glorious  fountains  in  the  Piazzo  di  Spagna 
and  the  Piazzo  Navona. 

The  Eomans  not  only  provided  great  aqueducts 
for  the  Imperial  City,  but  also  built  them  through- 
out various  parts  of  the  Empire.  In  Pome,  the 
aqueducts  were  built  to  supply  both  the  low 
and  the  high  levels  of  the  city.  The  reason  why 
the  Eomans  did  not  build  underground  aqueducts, 
as  is  done  at  the  present  day,  has  been  variously 
explained.  Perhaps  they  did  not  fully  under- 
stand that  water  will  find  its  own  level  over  a 
great  distance.  They  also  would  have  found  great 
difliculty  in  overcoming  the  high  pressure  of  the 
water. 

In  their  conduits  they  built  shafts  at  frequent 
intervals  designed  to  relieve  the  pressure  of  com- 

^  "  Diet,  of  Gr.  and  Eom.  Antiq.,"  Smith,  vol.  i,  p.  150,  to 

tuhich  the  author  is  indebted  for  much  of  the  information  herein 
supplied. 


SANITATION  157 

pressed  air  in  the  pipes.  The  water  from  the 
neighbourhood  of  Borne  rapidly  encrusted  channels 
and  pipes  with  calcareous  deposits.  Probably  the 
great  advantage  of  accessibility  to  leaks  and  defects 
gained  by  building  unenclosed  aqueducts  appealed 
strongly  to  the  ancient  Komans.  They  did  not 
fully  understand  the  technical  difficulties  involved 
in  the  "hydraulic  mean  gradient."  No  machinery 
was  used  to  pump  the  water  or  raise  it  to  an 
artificial  level.  A  strip  of  land  15  ft.  wide  was 
left  on  either  side  of  the  aqueducts,  and  this  land 
was  defined  at  intervals  by  boundary  stones.  No 
trees  were  grown  near  the  aqueduct,  to  avoid  the 
risk  of  injuring  the  foundations,  and  any  breach 
of  the  rules  for  the  preservation  of  the  aqueducts 
was  severely  punished  by  fines. 

Vitruvius  gives  rules  for  testing  the  water,  and 
points  out  that  water  led  through  earthen  pipes  is 
more  wholesome  than  water  coming  from  leaden 
ones.  He  states  that  the  "fall"  of  an  aqueduct 
should  be  not  less  than  1  in  200.  A  circuit  was 
often  made  to  prevent  the  too  rapid  flow  of  the 
water,  and  intermediate  reservoirs  were  constructed 
to  avoid  a  shortage  of  water  in  the  case  of  a  broken 
main.     Beservoirs  were  also  used  for  irrigation. 

The  water  from  the  aqueduct  was  received  at 
the  walls  of  the  city  in  a  great  reservoir  called 
castellum  aquarum,  externally  a  beautiful  building 
and  internally  a  vast  chamber  lined  with  hard 
cement  and  covered  with  a  vaulted  roof  supported 


158  GREEK  AND  EOMAN  MEDICINE 

on  pillars.  The  water  flowed  thence  into  three 
smaller  reservoirs,  the  middle  one  filled  by  the  over- 
flow of  the  two  outer  ones.  The  outer  reservoirs 
supplied  the  public  baths  and  private  houses,  while 
the  middle  one  supplied  the  public  ponds  and 
fountains,  so  that,  in  the  event  of  a  shortage  of 
water,  the  first  supply  to  fail  was  the  least 
important.  The  amount  of  water  provided  for 
private  use  could  be  checked,  for  purposes  of 
revenue,  by  means  of  this  arrangement. 

At  first  the  aqueducts  were  not  connected  with 
private  houses,  but,  later,  private  persons  were 
allowed  to  buy  the  water  which  escaped  from 
leaks  in  the  aqueducts.  Next,  private  connections 
were  made  with  the  public  mains,  and,  finally, 
reservoirs  were  built  at  the  expense  of  adjoining 
households,  but  these  reservoirs,  although  built 
with  private  money,  were  considered  part  of  the 
public  property.  Water  rights  were  renewed  with 
each  change  of  occupant.  The  water-supply  to  a 
house  was  measured  by  the  size  of  the  pipe  through 
which  it  passed  at  the  in-flow  and  at  the  out-flow 
of  the  reservoir. 

The  curatores  aquarum  had  very  responsible 
duties.  Under  their  orders,  in  the  time  of  Trajan, 
were  460  slaves  who  were  subdivided  into  various 
classes,  each  of  which  had  its  own  particular  duties 
to  perform  in  connection  with  the  maintenance  and 
control  of  the  water-supply.  A  supply  of  pure 
water  and  proper  drainage  are  of  first  importance 


SANITATION  159 

in  sanitation,  and  it  is  evident  that  the  Eomans 
understood  these  matters  well.  ^ 

Dbainage. 

The  drains  of  Athens,  built  of  brick  and  stone 
and  provided  with  air-shafts,  ran  into  a  basin 
from  which  pipes  carried  the  sewage  beneath  the 
surrounding  plain  which  it  helped  to  fertilize. 

The  chief  drain  of  Eome  was  the  Cloaca  Maxima, 
and  there  was  a  great  network  of  smaller  drains. 
The  privy  in  private  houses  was  usually  situated 
near  the  kitchen,  and  a  common  drain  from  the 
kitchen  and  the  privy  discharged  into  the  public 
cloaca.  A  pipe  opened  just  above  the  floor  of  the 
closet  to  supply  water  for  flushing.  Euins  of  very 
small  rooms  have  been  discovered  in  the  Via  Sacra 
of  the  Eoman  Forum,  and  it  has  puzzled  archaeolo- 
gists to  discover  their  use,  but  they  are  thought  to 
have  been  sanitary  closets.  The  sewers  of  Eome 
drained  into  the  Tiber. 

Disposal  of  the  Dead. 

Both  in  Greece  and  Eome  earth-burial  and 
cremation  were  employed  for  the  disposal  of  the 
dead.  Near  the  Temple  of  Faustina  in  the  Eoman 
Forum,  under  the  Via  Sacra,  have  been  found  the 
graves  of  some  of  the  dwellers  of  the  hills  before 
Eomulus  founded  the  city.  In  Eome,  burial  within 
the  city  was  forbidden  from  the  time  of  the  Twelve 
Tables.    Exceptions   were    made   in    the   case   of 


160  GREEK  AND  EOMAN  MEDICINE 

emperors,  vestal  virgins,  and  famous  men,  such  as 
those  who  had  been  honoured  with  triumphs.  The 
large  cemetery  for  the  poor  lay  on  the  east  side 
of  the  city  and  the  tombs  of  the  rich  were  along 
the  roadsides.  The  remains  of  some  of  these  can 
now  be  seen  along  the  Appian  Way.  One  of 
these  tombs  is  the  Tomb  of  the  Scipios,  which, 
as  Byron  wrote,  "  contains  no  ashes  now."  Near 
the  Tomb  of  the  Scipios  can  be  seen  a  door  with 
high  steps  which  leads  to  the  columbaria.  These 
are  little  rooms  provided  with  pigeon-holes  for 
the  reception  of  the  ashes  of  the  freedmen  of 
notabilities.  Inscriptions  show  that  some  of  these 
freedmen  were  physicians,  and  others  musicians 
and  silversmiths.  The  shops  of  the  perfumers  stood 
in  a  part  of  the  Forum  on  the  Via  Sacra.  Per- 
fumes were  much  used  at  incinerations  to  dis- 
guise the  smell  of  decomposition  before  the  fires 
were  kindled.  The  Christians  opposed  cremation 
and  favoured  earth  burial,  and  in  time  the  busi- 
ness of  the  perfume-sellers  failed,  and  Constantine 
bought  their  shops. 

The  Catacombs  were  used  almost  entirely  by  the 
Christians.  If  all  the  passages  of  the  Catacombs 
could  be  placed  in  line,  it  is  said  that  they  would 
extend  the  whole  length  of  Italy.  They  were  hewn 
out  of  volcanic  soil  very  well  suited  for  the  purpose, 
and  were  probably  extensions,  in  the  first  place,  of 
quarries  made  for  the  purpose  of  obtaining  building 
cement.    They  were  used  by  the  Christians,  not  only 


SANITATION  161 

for  the  religious  rite  of  burial,  but  also  as  secluded 
meeting  places.  The  bodies  were  laid  in  loculi, 
sometimes  in  two  or  three  tiers,  the  loculi  being 
filled  in  with  earth  and  stone. 

Many  of  our  public  health  regulations  had  their 
counterpart  in  ancient  times,  for  instance,  any 
factory  or  workshop  in  Kome  which  created  a 
public  nuisance  had  to  be  removed  outside  the 
city.  The  spoliarium  of  the  Coliseum  was  an 
ancient  morgue. 

A  detached  building  or  room,  valetitdinarium, 
was  provided  in  large  houses  for  sick  slaves.  This 
was  for  the  purpose  of  preventing  infection  as  well 
as  for  convenient  attendance  on  the  sick. 


11 


162 


APPENDIX. 

FEES  IN  ANCIENT  TIMES. 

The  professional  incomes  of  doctors  in  ancient 
G-reece  and  Eome  varied  greatly  as  at  the  present 
day.  A  few  were  paid  very  large  fees,  but  the  rank 
and  file  did  not  make  more  money  than  was  equal 
to  keeping  them  in  decency. 

Seleucus  paid  Erasistratus  about  ii'20,000  for 
curing  his  son  Antiochus.  Herodotus  mentions 
that  the  ^ginetans  (532  B.C.)  paid  Democedes, 
from  the  public  treasury,  X'304  a  jesiY  ;  the 
Athenians  afterwards  paid  him  £406  a  year,  and 
at  Sam  OS  he  received  £422  yearly.  Pliny  says 
that  Albutius,  Arruntius,  Calpetanus,  Cassius  and 
Eubrius  each  made  close  upon  j£2,000  a  year,  and 
that  Quintus  Stertinius  favoured  the  Emperor  by 
accepting  about  j£4,000  a  year  when  he  could  have 
made  more  in  private  practice.  The  surgeon  Alcon 
made  a  fortune  of  nearly  ^6100,000  by  a  few  years' 
practice  in  G-aul.  Pliny  states  that  Manlius  Cor- 
nutus  paid  his  doctor  £2,000  for  curing  him  of  a 
skin  disease,  and  Gralen's  fee  for  curing  the  wife 
of  a  consul  was  about  <£400  of  our  monev. 


163 


INDEX. 


Academics,  56 

Adamantius,  116 

Adams  of  Banchory,  31,  32,  124 

^sculapius,  3,  13,  14 

— ,  College  of,  6 

— ,  temple  of,  4,  14,  17 

^tius,  118 

Agathinus,  87 

Agrippa,  63 

Alexander  of  Tralles,  119 

Alexander  the  Great,  38,  40,  41 

Alexandria,  42 

Alexandrian  School,  42 

Anatomy,  27,  44,  46,  76,  101,  140 

Andromachus,  68,  82 

Antonius  Musa,  65 

Antyllus,  112 

Apollo,  3,  13 

ApoUonius,  80 

— ,  alleged  miracles  of,  81 

Aqueducts,  9,  155 

Archagathus,  5 

Archiater,  6,  68 

Arohigenes,  88 

Aretseus,  87 

Aristotle,  25,  40 

Asclepiadse,  18,  40,  44 

Asclepiades  of  Prusa,  23,  51,  146 

Asklepieion  of  Cos,  19 

Astrology,  68 

Athenssus,  86 

Athletes,  147 

Augustus,  63 

Aurelianus,  91 

Baths,  Greek,  148 
— ,  Roman,  119 


Baths  of  Caracalla,  44,  153 

—  at  Pompeii,  152 
Byzantine  Period,  111 

Oabalists,  128 
Cselius  Aurelianus,  91 
Caesar ,  Julius,  44,  54,  55 
Caligula,  67 
Caracalla,  44,  153 
Cassius  Felix,  89 
Catacombs,  160 
Cato  the  Elder,  7,  8 
Celsus,  48,  72 
— ,  works  of,  73 
Christ,  miracles  of,  138 
Christianity,  128 

—  and  hospitals,  133 
Chrysippos,  46 
Claudius,  67 
Cleombrotus,  46 
Cloaca  Maxima,  8,  159 
Cnidos,  17,  44,  50 
Constantino,  130 
Cornelius  Agrippa,  1 
Cos,  17,  44 
Cremation,  159 

Decline  of  Healing  Art,  111 

—  of  Rome,  111 
Democedes,  22 
Democritus,  23,  25 

Demon  Theories  of  Disease,  136 
Dietetics,  32,  103 
Dioscorides,  88 
Disposal  of  the  dead,  159 
Dogmatic  School,  23 
Drainage,  159 


164 


GREEK  AND  ROMAN  MEDICINE 


Drug-sellers,  59 

Eclectics,  87 
Elements,  the  four,  39 
Empirics,  23 
Empiricism,  23,  48 
Epicureans,  56 
Erasistratus,  45,  47 
Essenes,  45,  127 
Euclid,  43 ' 
Eudemus,  79 

Fabiola,  135 
Fees,  162 

Galen,  96,  146 
— ,  influence  of,  110 
— ,  works  of,  99 
Gibbon,  10,  56,  120,  140 
Gladiatorial  games,  130 
Gladiators,  147 
Gnostics,  128 
Gods  of  disease,  3 

—  of  healing,  3,  15 
Gorgias,  25 
Gymnasia,  19,  145 
Gymnastics,  143 

— ,  inventor  of  medical,  146 
— , -opinions  of  physicians  on,  146 
Gymnasiarch,  20,  144 
Gynsecology,  31,  93,  107 

Heliodoeus,  91 
Herodicus,  25 
Herodotus,  22,  91 
Herophilus,  45,  46 
Hippocrates,  7,  25,  146 
— ,  sons  of,  37 
— ,  works  of,  26 
Hippocratic  Law,  33 

—  Oath,  35 
Homer,  15,  16,  148 
Horatillavus,  61 
Hospitals,  183 

— ,  founders  of,  135 
Hygeia,  15 

locus,  146 


Jacobus  Psychristus,  116 
Justinian,  130 

Lectisteenium,  3 
Leucippus,  23 
Library  of  Alexandria,  43 
Livy,  2,  4 

Machaon,  16,  17 
Maecenas,  66 
Magnus,  116 
Marinus,  95 
Meges  of  Sidon,  79 
Melampus,  15 
Meletius,  116 
Methodism,  23,  51,  54 
Miracles  of  Apollonius,  80 

—  of  Christ,  138 

—  of  Vespasian,  140 
Mithridates,  45 
Mithridaticum,  45 
Monastic  medicine,  137 
Moschion,  123 

Nemesius,  116 
Neoplatonism,  112 
Nero,  67,  69,  70 
Nerva,  81 
Numa  Pompilius,  2 

Obsteteics,  31,  93 
Octavianus.  55 
Oculists,  70 
Operations,  29,  30,  73,  113 

—  dental,  2 
Oribasius,  87,  93,  114 
Orphanages,  132 
Ovid,  24 

Pathology,  104 

Paulus  ^gineta,  94,  113,  124 

Period,  anatomic,  21,  45 

— ,  philosophic,  21 

— ,  primitive,  20 

— ,  sacred,  21 

Pestilence  in  Rome,  89 

Philenus  of  Cos,  48 

Philosophy,  56 


INDEX 


165 


Plague,  4,  120 

Plato,  25,  39 

Platonists,  56 

Pliny,  3,  52,  65,  72,  84,  146 

Plutarch,  5,  7 

Pneumatism,  86 

Podalarius,  16 

Poisoners,  women,  70 

Priest-physicians,  1,  134 

Priests,  18 

Proclus,  140 

Ptolemy,  43 

Public  health  regulations,  161 

Pythagoras,  21 

Pythagoreans,  22 

Quacks,  58,  61 
Quintus,  95 

Rhodes,  17 

Roman  quacks,  58,  61 

Rome,  56 

— ,  medical  practice  in,  58 

Rufus  of  Ephesus,  94 

Saints,  138 
St.  Luke,  139 
St.  Paul,  139,  148 
Sanitation,  8,  155 
Sceptics,  24 


Scribonius  largus,  82 
Seneca,  67,  131 
Serapion,  50 
Serpents,  14 
Sewers,  8,  9,  159 
Slave-physicians,  60 
Slaves,  60 
Soranus,  92 
Stoics,  56,  129 
Suetonius,  140 
Surgery,  30,  73,  107 
Surgical  instruments,  90 

Tacitus,  140 

Temple  of  ^Esoulapius,  4,  14,  17 

Temples,  3,  4,  17 

Themison  of  Laodicea,  23,  53,  54 

Theophrastus,  42 

Theriaca,  98 

Thermae,  152 

Thessalus  of  Tralles,  83 

Thrasyllus,  66 

Tiberius,  66 

Ybttius  Valleus,  82 
Vitruvius,  144,  157 

Water  supply,  63,  155 
Women  poisoners,  70 
Wounds  of  Julius  Csesar,  55 


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